Universal aligning adaptor system and methods

ABSTRACT

A system for dental implant restoration is provided. It includes universal aligning adaptors and prosthetic components having co-operable indices, which together form a translational, integrating system which aligns, synchronizes, and references the prosthetic components about an implant&#39;s central axis of rotation. Rotation of an adaptor about a prosthetic component, with its reference point becoming aligned to a predetermined reference point on the prosthetic component, followed by the rotation of the adaptor/prosthetic component assembly about the implant, situates the prosthetic component in a predetermined position such that all other prosthetic components become synchronized to the adaptor&#39;s reference point. The prosthetic component is mechanical for clinical or lab bench use, or is virtual for restoration design in a software program, prior to milling prosthetic abutments or devices. Abutments, healing caps and screw access holes are realigned to preferred positions and synchronized with minimal deviation from the ideal direction.

CROSS-REFERENCE TO RELATED APPLICATIONS/INCORPORATION BY REFERENCE

This application is a continuation of U.S. patent application Ser. No.15/162,305, filed May 23, 2016, which is a continuation of U.S. patentapplication Ser. No. 14/085,286, filed Nov. 20, 2013, which claims thebenefit of U.S. Provisional Patent Application No. 61/796,837, filedNov. 20, 2012. The contents of each of these applications are expresslyincorporated herein by reference in their entireties.

FIELD OF THE INVENTION

This application relates to restoration of implant fixtures includingsystems, components and methods for their restoration.

THE TECHNOLOGY

The present application discloses, through a plurality of device andmethod innovations, a Universal Aligning Adaptor System and noveldevelopments in implant restorative dentistry. The present applicationfurther establishes unique methods for coordinated physical and/orvirtual alignment, referencing and synchronization of prosthetic dentaldevices across all stages of the restorative process, from surgicalplanning to dental prosthesis fabrication. Through a revolutionarystructure of relational geometry, the present application affords aquantifiable associative linkage of prosthetic dental devices to anunderlying implant and to each other, such that the prosthetic dentaldevices can be positioned and situated to a high degree of aesthetic andclinical satisfaction using an automated and/or interactive clinicaland/or digital protocol.

Implant misalignment can result from inherent perturbations in theprocess of drilling osteotomy sites and the subsequent surgicalinsertion of the implant fixtures into the bone. This misalignment cannow be overcome via the present application's innovations, including,but not limited to, the use of a plurality of predetermined horizontalrotational reference points. These reference points include an index forthe demarcation of the specific angular relationships between an implantand its restorative elements. These reference points can be used aloneor in combination with Universal Aligning Adaptors to couple the indicesof co-operable, referencing, interim and/or final prosthetic dentalcomponents for interconnection with each other in relation to theunderlying implant index to obtain a registration of the realignedmutual geometry of the componentry referenced to the implant.Accordingly, the application allows for a precise aesthetic andclinically ideal alignment and positioning of the final dentalprosthesis via synchronization of the indices.

The present application provides significant improvements overconventional approaches, including those established in, and coveredunder, this inventor's previous devices and methods, “Implant Collar andPost System” U.S. Pat. Nos. 5,195,395; 5,238,405; and 5,350,302; and“Method of Forming an Abutment Post” U.S. Pat. Nos. 5,439,380 and5,564,921. In particular, the linkage and use of the indices provides acoordinating structure to facilitate the alignment and situation ofprosthetic dental devices over the jaw in a precise, repeatable andclinically ideal manner. The present application obviates the need for acollar-type device requiring “fit-and-test” horizontal rotations fordental prosthesis alignment, that process being subject to thelimitations of practitioner accuracy and expertise. As such, the presentapplication is designed to eliminate practitioner error when, forexample, either impressions or intraoral, bench, CT, or otherimaging/sensing scans are taken and models are made and/or digital datais collated, as the restorative componentry can only be connected andinserted in a set manner as dictated by the alignment, referencing andsynchronization mechanism afforded by the indices.

This application relates to the prosthodontic restoration of previouslyplaced dental implant fixtures that have been surgically implanted inthe edentulous area(s) of the alveolar bone, and are ready forrestoration with a crown, set of crowns, or a bridge or any type ofscrew borne prosthesis using one or more universal aligning adaptors,prosthetic components with co-operable indices, and a predeterminedclinical and/or digital protocol. The universal aligning adaptor systemaligns and synchronizes all prosthodontic restoration componentry. Thus,using referencing devices that include an array of impression posts,intraoral or bench scanning posts, or CT scan posts one can register thenewly established, preferred position and/or gingival architecture of anabutment and/or the preferred screw access hole locations for thefabrication of one of the prostheses listed above.

BACKGROUND OF THE INVENTION

“Surgical error” is inherent to the drilling of the osteotomy sites andthe subsequent insertion of the implant fixtures, and, more often thannot, results in implants being placed at a less than an ideal verticalangle or horizontal position. Some of the causes of the verticalangulation/position issue include tilting a hand piece by even just afew degrees, which can result in the head of the implant beingmisdirected several or more millimeters away from its intended position;drilling osteotomy sites without using a surgical guide, which canresult in random implant fixture placement; and compensating forexisting natural bony undercuts by angling the drill during sitepreparation. Any one of these errors can dramatically alter theimplant's position away from its intended ideal location.

However, while vertical angulation can be an impediment to easyfabrication of implant abutments and/or prostheses with natural anatomicform, the most insidious and compounding problem is the misalignment ofthe implants' indexes. This misalignment results from arbitraryinsertion of the implants by a surgeon, as the surgeon's first priorityis properly securing the implants to the bone. In securing an implant tothe bone, the surgeon is solely concerned with either sufficientlytightening the implant without over-tightening and thereby potentiallystripping the bone during the tightening procedure, or with placing theimplant at the crest of bone or below it as a first priority. An implantthat has been over-tightened or under-tightened is at risk of failure.Because proper securement of the implant is the primary, if not only,consideration of the surgeon, the surgeon cannot guarantee that theimplants' indexes are situated so that their axes bisect the ridge inthe sagittal plane at their center points. In fact, this frequentmisalignment of the indexes magnifies vertical angle and positionalissues, especially as the number of sides of the implant index decrease,which severely limits the rotational options to increasingly coarseincrements. For example, a dodecagon with twelve sides has a 30°rotation, an octagon with eight sides exhibits a 45° rotation, a hexagonwith six sides turns with a 60° rotation, and a tripod with three sideshas a 120° rotation which, at a minimum, requires altered six sidedabutments just to achieve a 60° rotation (see FIGS. 13-23 ).

To varying degrees, even experienced practitioners can find itchallenging to fabricate restorations that are not too bulky or thathave access holes in locations that are not too difficult to manipulate(see FIGS. 62-69C). As a result of these issues, implant companies havegone to great lengths to compensate for these “off-angle” implants withabutment and prosthesis products that by-pass these misaligned indexes,have anatomic forms that have to be cast or milled from the bottom up tocompensate for the misalignment; or have connecting cylinders that lackanti-rotation features to avoid parallelism issues, to name just a few.

The universal system of the present application resolves theseangulation/misalignment problems for all implants by rotating theabutments and/or prosthetic components in 15° increments or less,regardless of whether the implant's index is a dodecagon (23), octagon(24), hexagon (22), nonagon (25), quadragon (not shown) or even atrichannel (21) (see FIGS. 13-23 ). As shown in FIGS. 2 and 3 , theimplant's index (15) comprises an internal mating surface which isintended to pair with an external mating surface of the correspondingindex of the adaptor.

In certain embodiments, the abutment/adaptor assembly achieves anoptimal positioning within a maximal 7.5° deviation from the idealdirection when rotating in 15° increments. Along with this repositioningcapability, the universal system can realign the implant indexes suchthat the abutments, healing caps, impression posts, scanning posts, andscrew access holes are situated and aligned by the newly reestablishedrelationship of the primary and secondary indicia of the universalaligning adaptor and its prosthetic components having co-operableindices.

The innovative devices and methods to be used in conjunction with theuniversal aligning adaptor to realign, situate, and standardize abutmentplacement; to synchronize all prosthetic components, and to referencethem is described below.

SUMMARY OF THE PRESENT INVENTIONS

Overview

The Universal System dramatically redefines the way dental implants arerestored. It provides a unique combination of universal aligningadaptors and prosthetic componentry having co-operable indices with auniversal preconfigured clinical and/or digital protocol to align,synchronize, and reference these components around the implant's centralaxis of rotation, which eliminates the outsized negative influence thatimplant index misalignment has had on implant restoration up until now.Prosthetic components, devices and prostheses no longer have less thanideal emergence profiles and positions, and those that are screwretained are no longer encumbered with screw access holes exiting inawkward locations. When the prosthetic components' co-operable indicesinclude primary and secondary indicia, they are rotatable about theirindividual adaptors to position them in preferred vertical andhorizontal predetermined positions, and they are then synchronized tothe primary indicia of the adaptors in their new positions. Once alignedand synchronized, they are easily registered by impression, intraoral orbench scan or cone beam CT scan (CBCT) posts and techniques, which aresituated in relation to the primary indicia of the adaptors, and,thereby, allows for the systematic fabrication of prosthetic devices andprostheses, regardless of any particular implant's index configurationor misalignment. The Universal System has been developed to serve everyskill level of practitioner, every member of the implant team, everycircumstance, and every type of implant restoration that is seated onany implant, regardless of the index configuration or misalignment. TheUniversal Aligning Adaptor system can be used with either a two stageinsertion/restoration process or with a single stage, immediate loadprocedure.

The innovations described in this application and summarized below (theUniversal Aligning Adaptor System, the Universal Contour AbutmentSystem, the Universal Multifunction Abutment System, the UniversalImpression, 3D Imaging and Milling System, Method of Aligning,Synchronizing, Referencing and Forming a Set of Universal Abutments, andMethod of Aligning, Synchronizing, 3D Imaging, and Milling ProstheticComponents and Devices) comprise a complete system for restoring anypreviously placed dental implant fixtures, which is referred to as theUniversal System. The Universal Aligning Implant System provides anideal implant index for inserting implants in a predictable, consistentmanner or for making precise horizontal angle corrections, in 5°increments when necessary.

The Central Axis of Rotation and the Primary Indicium

Irrespective of the available multitude of applied dental devices andtechniques, the discipline of implant restorative dentistry has a commongoal: produce an aesthetically pleasing restoration by situatingprosthetic dental componentry within the mouth in a clinically idealmanner. Ironically, a major challenge to achieving a successful outcomearises from one of the very first steps in the restorative process,specifically, anchoring the underlying implant device to the jaw. Whensurgically inserted, the positioning of the implant screw is subject toa number of complicating factors, including, but not limited to:physiology of the anchoring bone structures, precision of the surgicalguides and templates, and accuracy and skill of the practitioner. Theresult is that the central axis of the implant, the line of referenceextending along the body of the implant device, from the screw pointoutwards through the implant head at the jaw surface, is almost nevercoincident with the desired central axis of rotation, the target line ofreference established by the coaxial configuration of the plannedtopmost prosthetic component as it is situated over the implant's idealdevice location. As such, a clinically ideal restoration can only beachieved by employing a coordinated system to correct such inherentmisalignment, in effect transforming the otherwise immutable centralaxis of the implant into a workable central axis of rotation. To wit,when an underlying implant is misaligned such that an abutment engagingthe implant is not coincident with the desired central axis of rotation,there now exists a unique two- or three-space rotational transformationenabling mechanical or virtual repositioning of the abutment to allow itto become so aligned. This transformation is established by a universalreferencing device, comprised of a universal aligning adaptor having aprimary indicium reference point and an overlaying prosthetic inserthaving co-operable primary and secondary indicia. The predeterminedrotation of the adaptor about the prosthetic insert via there-established central axis of rotation situates the insert in agenerally desired horizontal and vertical position, thus identifying thealignment and synchronization points for all other co-operablecomponentry. The location of the adaptor's primary indicium in relationto the implant's index is the reference point for registering thenecessary transformation, which, in turn, determines the seating of theinterim preferred abutment or healing cap, prior to fabricating finalprosthetic components and/or devices with the same alignment by anautomated and/or interactive clinical and/or digital protocol.

The registration of the location of the primary indicium of the adaptorby an impression, a scan, or both identifies the desired central axis ofrotation for the fabrication of a custom cast or pressable abutment or amilled abutment, or any other abutment fabricated by any means.

When an abutment is created from a digital file after the repositioningof the clinical abutment, the data for this desired central axis ofrotation is translated to a software program's device methods andcontrols to perform an automated virtual realignment of thecorresponding virtual abutment in the program prior to milling theactual abutment. As such, when the implant's index alignment is capturedby an intraoral or bench scan or CBCT scan taken directly on theimplant, the rotation of the adaptor and the referencing device can beperformed in the software program according to the automated and/orinteractive digital protocol, which establishes the preferred position.

Since the scan post is seated in relation to the primary indicium of theadaptor, wherein the co-operable indices include primary and secondaryindicia such that the primary indicium of the adaptor is rotatable inrelation to the primary and secondary indicia of any prosthetic insert,it thus provides a predictable, reproducible intraoral, bench, CBCT (orother tomographic) scan. When taking a CBCT scan of the scan post inrelation to the hard structures of the jaw (including bone, teeth, andimplants), its location is defined in absolute, three dimensional terms,as directed by the unique design of the scan post, in combination withthe universal automated and/or interactive clinical and digitalprotocol.

Both the intraoral or bench scan and the CBCT scan posts can haveidentical primary and secondary indicia, which have been set in relationto the primary indicium reference point of the adaptor. Final prostheticdevices can be fabricated from an intraoral, bench, or CBCT scan, buttheir images can also be merged by overlaying their respective primaryindicia. The data for the implant position, the contour and angulationof the bone, and the gingival contours are now incorporated into asingle image, along with the position, geometry, and angulation of theideal abutment at that particular implant site. From this point, a finalabutment or set of abutments can be fabricated, along with theiroverlying prosthetic devices in appropriate cases using an automatedprotocol.

The Universal System provides the automated clinical and/or digitalprotocol for the fabrication of final abutments, including prostheseswith or without impressions having been taken. In one method, thisprotocol begins with the sculpting of the gingival tissue by the surgeonor restorative dentist, using the universal interim healing cap orinterim abutment as a surgical stent as the interim component isinserted so that the tissue conforms to its architecture. Taking thismethod one step further, when an impression or scan post is seated on anindexed healing cap having the identical gingival architecture as theinterim healing cap or abutment, and when the final abutment isdeveloped using that same matching gingival configuration, the processbecomes fully automated. Merging the subgingival device configurationsdata with the surface topography data allows the cast, pressed or milledabutment to be fabricated such that they replicate the ideal emergenceprofile. From the beginning, the gingiva has been effectively molded tothe architecture of the abutment, rather than the abutment being moldedto accommodate the gingiva after it has been fabricated, which can bequite time consuming and less accurate.

Furthermore, if the restorative process is accomplished via thecombination of an intraoral scan and a CBCT scan without any impressionhaving been taken, the abutments and their overlaying copings and/orframeworks can be simultaneously fabricated, since the positions ofco-operable components are absolute as determined by the CBCT scan, thusthe universal clinical and digital protocol is fully automated.

The restorative process begins with the surgeon or restorative dentistfirst rotating the interim healing cap or interim abutment having a basewith any preferred subgingival architecture to an ideal position andsculpting the tissue over the implant until the interim device is fullyseated. Once the tissue has molded to the interim device, in a preferredembodiment, it is removed and a matching indexed healing cap is insertedin the same position with the scan post seated on the indexed healingcap in relation to the primary indicium of the adaptor. The scan postcan also be seated directly on the adaptor such that their primaryindicia are coincident (without an interfacing indexed healing cap). Ineither example, the intraoral or bench scan and/or the CBCT scan aretaken and, if their images are to be taken together, their images can bemerged via their primary and secondary indicia, such that thesereference points overlay one other. The merged data now incorporates thefollowing: the absolute position of the preferred abutment relative tothe hard structures of the jaw (bone, teeth and implants); either theconfiguration of the healing cap or interim abutment, since it is anidentified part from a library of healing caps or interim abutments, orthe scan of the healing cap developed sulcus; and the surface topographyaround that implant. This data can then be input via the Universal ScanCode into the milling devices codes of the milling software program andthe virtual abutment can then be auto-rotated in the program into thepreviously established, preferred clinical position of the healing capor interim abutment, which, in turn, has been set according to thelocation of the primary indicium of the adaptor (position a, b, c,etc.). The configuration of the preformed gingival base used in theinterim healing cap or interim abutment can then be incorporated intothe data for the abutment (for example a particular maxillary centralincisor). Since all of the components are linked via the primaryindicium of the adaptor, the final abutments and copings and overlayingprosthesis can be fabricated. The same principals apply when fabricatinga castable or pressable abutment in the laboratory. The technicianmerely uses the castable or pressable gingival base having the sameconfiguration as the interim one, and, therefore, he does not have tomake any adjustments to the gingival contours.

The Practical Application of the Technology

When the implants are ready for restoration, Universal Aligning Adaptorswith mating indexes for their respective implants can be connected to aUniversal Contour or Universal Multifunction Abutment. The UniversalAligning Adaptors can be rotated to ideal positions according to a setof primary and/or secondary indicia that define the rotation and itsaligning mechanism. The combined adaptor/abutment assemblies can then berotated as needed and connected to the implants. In another technique,the Universal Aligning Adaptor can be first rotated to a predetermined,ideal position on the implant, with the abutment then being seated toits ideal position. Once the newly established position is registered,one of the overlying restorations is created, which, in turn, is seatedon the adaptor/abutment assemblies. The process can be completed eitherclinically with physical components or virtually within a softwareprogram. The components and methods for registering and creating thealigned and synchronized prosthetic components, devices and prosthesesare covered, in detail in the Universal Impression, 3D Imaging, andMilling System, Method of Aligning, Synchronizing, Referencing andForming a Set of Universal Abutments, and Method of Aligning,Synchronizing, 3D Imaging, and Milling Prosthetic Components and Devicessections of this application. The specific prostheses that are directlyconnected to the adaptor are covered in the Universal Contour AbutmentSystem and the Universal Multifunction Abutment System sections of thisapplication. Cast, pressable, and milled abutments of the universalsystem can also be fabricated such that they are directly connected tothe implant without any adaptor, after the preferred positions of theabutments have been established, synchronized, and referenced asdescribed below.

The Universal Aligning Adaptor is a translational, integrating devicethat aligns and synchronizes all componentry seated on its shoulderaccording to a preconfigured clinical and/or digital protocol whereinthe primary indicium on its top end (abutment engaging index on its topsurface) is positioned in relation to a primary or secondary indicium ofits overlying abutment, regardless of the index or configuration of theunderlying implant upon which it is being seated (see FIGS. 25A-F). Thealigning or realigning of the primary indicia of the adaptor with theprimary and secondary indicia of the abutment, as it is rotated into anideal position, creates a set of reference planes that synchronize theseating of the abutment and all subsequent componentry in relation tothe adaptor's primary indicium, and, thereby, to each other and to theimplant's index. As such, no matter what the misalignment of theimplant's index, healing caps and abutments can be realigned andsituated in their sagittal and coronal planes, drawn along theirrespective primary indicium lines, and substantially perpendicular tothe ridge of the jaw. These reference planes can then be utilized toseat the adaptor/abutment assembly at the indicated point, or at anotherpreferred, predetermined position in relation to it (see FIGS. 24A-I).

The primary indicium of the adaptor and the primary and secondaryindicia of its prosthetic components that have co-operable indices canbe any type of mark or identifying polyhedron. In certain embodiments,the mark or identifying polyhedron is a protrusion. In otherembodiments, the mark or identifying polyhedron is painted or etchedonto the surface of the adaptor. In one embodiment, the primary indiciumof the adaptor is a sphere or other protruding polyhedron, which, incertain embodiments, may be spring loaded with the primary and secondaryindicia of the prosthetic devices having a matching recess at each ofits secondary indicia such that the adaptor engages the secondary indiumwith a “positive feel” to ensure its proper seating during the rotation(see FIGS. 1-2, 9A-10C).

In some embodiments, the predetermined rotation of the adaptor's primaryindicium around the prosthetic component's primary and secondary indiciaand the adaptor/prosthetic component assembly around the implant definesthe alignment of the adaptor and its overlying componentry, whereinthese definitive increments of rotation ensure a more exact alignmentand establish a reference point in relation to the implant's rotationalposition for synchronization of all other prosthetic componentry. Incertain embodiments, the universal aligning adaptor has a top end studon its top surface configured to receive a prosthetic component and iscomprised of any polygon having “n” equal sides that is dissimilar tothe polygon at its bottom surface that engages the implant index, andhas a randomly chosen primary indicium on one of the “n” sides. When theadaptor is rotated according to the universal automated and/orinteractive clinical and/or digital protocol, the primary indicium onits top end will rotate in finite increments that are 15° or less, whenthe top end polygon is an octagon and the bottom end polygon engages animplant with either a trichannel, hexagon, dodecagon, or any other indexwhose “n” sides is a multiple of 3, and will rotate in 10° incrementswhen the polygon at the top end is a nonagon and the one at the bottomend is a quadragon. When the top end polygon of the adaptor is a hexagonand the bottom end polygon is an octagon, its primary indicium will alsorotate in the same 15° increments. In either case, this translates to arotation of an abutment or healing cap or other prosthetic component,device, or prosthesis around the implant with a maximal 7.5° deviationfrom the ideal direction, being at most ½ turn between rotationalincrements, such that any further turn is nothing more than a mirrorimage rotation of the previous one. With this dramatic reduction inrotation to 15° increments for a trichannel (vs. 120° rotation), hexagon(vs. 60° rotation), dodecagon (vs. 30° rotation), or octagon (vs. 45°rotation), or with the reduction in rotation to 10° increments for aquadragon (when the abutment engaging index is a nonagon) vs. (90°rotation), any of these implants having their indexes misaligned duringplacement by the surgeon can be more effectively restored by preciselypositioning the appropriate vertical angle correcting abutment such thatthe abutment's, prosthetic device's, or prosthesis's proper emergenceprofile and anatomic form are ideally situated, and/or have a screwaccess channel that is relocated closer to the central axis of thereplacement tooth used to restore that implant than is presentlyavailable. In addition, it opens the door for including anterior screwdown crowns because of the precisely positioned lingual crown fixationscrew. Furthermore, with the primary indicium of the adaptor beingrotated in relation to a primary or secondary indicium of the overlyingabutment as described above, the rotation can be predetermined andautomated.

The universal automated, interactive clinical and/or digital protocolthat is applied to the universal aligning adaptor having prostheticcomponentry with co-operable indices can allow for the rotation of theprosthetic components to ideal positions using predetermined referencepoints to effect the rotation. With this protocol, predetermined primaryand secondary referencing rotation points can be provided for anautomated rotation of the universal aligning adaptor with varyingdegrees of rotation. These referencing rotation points are different foreach implant having a different index. For example, a predeterminedcounter clockwise rotation of the adaptor to a predetermined position“a” around the abutment for the hexagon indexed implant, will result ina needed 15° horizontal rotation of the abutment to a preferred positionafter the adaptor/abutment assembly is subsequently rotated such thatthe abutment's primary indicium is substantially perpendicular to theridge of the jaw at that preferred position (see Tables 1-5, infra).However, in order to achieve the rotation of the adaptor around theabutment and the adaptor/abutment assembly around the implant for atrichannel indexed implant, the predetermined rotation position of theadaptor around the abutment is a clockwise rotation to position “B,” asecond rotation stop, which will result in the abutment being situatedin the preferred position after the rotation of the abutment/adaptorassembly. The universal automated clinical and digital protocol has setsof rotation points for creating predetermined horizontal rotations thatare specific for each different implant index. These rotations areachieved either clinically, digitally within a software program, or on aworking model.

Incorporating the scan code and the milling device codes of theuniversal automated and/or interactive clinical and digital protocolinto any software program for milling abutments and/or prosthesesideally situates virtual abutments prior to milling them, which improvestheir anatomic form. When “dialing in” the primary indicium referencepoint in relation to the primary or secondary indicium of the abutment,the virtual abutment can be automatically rotated into position. Incertain embodiments, the virtual abutment can be directly rotated tonegotiate the preferred position or can be used to adjust the autorotated virtual abutment's position. Of course, the rotation of thevirtual or the preformed abutment is contingent on translating theinterim abutment's or healing caps' position as it is referenced byusing the above protocol, or, via the interactive aspect of theprotocol, the technician can modify the rotation into a more preferredlocation (see FIGS. 10A-11C, 24A-25F).

Once alignment is completed, synchronization of the referencing devices(universal impression posts, intraoral or bench scanning posts and CTscan imaging posts) occurs as they are seated such that their primary orsecondary indicia are situated in relation to the same primary indiciumof the adaptor. The devices and methods of registering the location ofthe primary indicium and the chosen primary or secondary indicia of theabutment or healing cap are covered in detail in the UniversalImpression, 3D Imaging, and Milling System, Method of Aligning,Synchronizing, Referencing and Forming a Set of Universal Abutments, andMethod of Aligning, Synchronizing, 3D Imaging, and Milling ProstheticComponents and Devices sections of this application.

The universal aligning analog (see FIG. 94 ) is a translational,synchronizing analog that can be a one piece, double index componentthat, at its top end, replicates the adaptor's abutment engaging index,configuration, and position, and on its shank has the same polygonalconfiguration as the bottom end of the adaptor that engages the index ofthe implant being restored. The shank of the analog can be taperedenough to be removable, but not so much as to affect its immobility whenbeing used in the model. In one embodiment, a cross linking (horizontal)fixation screw can also be used to further secure the analog. Theuniversal aligning analog provides rotation for realignment of anabutment to another preferred position, after a model has beenfabricated in order to make an additional horizontal and/or verticalangle correction. In short, it is removable and rotatable, and correctsfor implant misalignment. In one embodiment, it provides the exact same15° increments of rotation as provided by certain embodiments of theadaptor around the abutment and the assembly around the implant. And,therefore, it can mimic the aligning process of the adaptor as outlinedin the automated and/or interactive clinical protocol described above.If a milled abutment is to be fabricated to fit on an adaptor ordirectly to the implant's index, then a scanning post can be inserted onthe analog such that its primary indicium overlays that of the analogand a bench scan can be performed. Once the abutment of any type isready for restoration and the crown has been fabricated, the technicianinserts the abutment on an adaptor such that the appropriate secondaryindicium is seated over the adaptor's primary indicium that is in thesame position established by the analog (for example, position “a” vs.“b”).

The universal aligning analog is particularly useful for prepositioningabutments in a CT scan generated model prior to the conversion of a fulldenture to a screw retained transitional prosthesis after the insertionand immediate load of four or more implants. Abutments can berepositioned by rotating the analog such that its primary indicium islocated under one of the primary or secondary indicia of a chosenabutment, which is then relocated to a more ideal situation on themodel. The screw access holes are then precisely drilled in the denturein a more centered location. The denture is then seated over theabutments and their adaptors such that they are positioned as they wereon the model, which will align them within the previously drilled accessholes.

By providing alignment and synchronization of all components, andreferencing devices along with the protocol for registering the adaptorposition all of which correct for abutment misalignment, the UniversalAligning Adaptor System breaks open the door for extensive innovation inall areas of implant restoration including new advances in intraoral andbench scanning and CBCT scanning. The system can even facilitate themerging of the images obtained from both the intraoral or bench scan andthe cone beam CT scan.

As a result of the alignment, synchronization, and referencing possiblewhen using either a physical or a virtual aligning adaptor, theprosthetic component, device, or prosthesis can be ideally positioned.As stated, the universal aligning adaptor is a translational,integrating device that aligns, synchronizes, and references all of theother componentry. All of the examples described below are only justthat, examples. They are not introduced as evidence that this is theonly embodiment being claimed in each case. In short, in most cases,only one embodiment out of many is being presented to provide anoverview of the technology.

The Universal Contour Abutment System

The Universal Contour Abutment System (see FIGS. 27-48 ) discloses a setof physical or virtual preformed universal contour abutments havingasymmetric configurations for restoring implants with a crown, set ofcrowns, or bridge, which can be rotated around their adaptors followedby their adaptor/assemblies around the implants until their customgingival contours and/or tooth preparations are ideally situated. Itsimplifies fabrication of castable and pressable abutments by providinghim with a preformed shape to customize, in preference to free handwaxing them. The contour abutment system provides comprehensive tissueengineering that extends from implant exposure until final abutmentinsertion that begins with the insertion of healing caps and/or interimabutments having the desired gingival contours which initiates tissuetraining; is followed by registration with impression, scanning, orimaging posts with or without matching gingival contours which are usedto register these contours as described above; and final preformed,cast, pressed, or milled abutments with matching gingival contours toreplace the interim devices. As stated, when creating milled abutments,virtual abutments can be clinically mechanically rotated or auto rotatedin a software program by integrating the universal aligning scan codewith the milling device codes and controls of the program as shown inthis patent application. The Universal Contour Abutment System alsodemonstrates a unique set of guided tissue punches that foster precisegingival incision lines over any implant, regardless of its angle orindex misalignment. The Universal Contour Abutment System can also havea plurality of abutments with screw threads that are ideally positionedin relation to the abutments' primary indicia for the best esthetics andfunction when affixing anterior and posterior screw retained crowns ofany type to them. For the first time, screw retained crowns withpredictably located screw thread channels in ideal positions areavailable for any implant at any vertical angle with any indexalignment.

The Universal Multifunction Abutment System

The Universal Multifunction Abutment System (see FIGS. 49-69C) disclosesa set of physical or virtual universal multifunction abutments used forrestoring implants with a screw retained hybrid prosthesis, anoverdenture prosthesis, a crown, set of crowns, or bridge with orwithout denture flanges. The Multifunction Abutments can be rotatedaround adaptors followed by their adaptor/assemblies around the implantsuntil their screw access holes are more in line with the central axis ofthe replacement teeth seated on the prosthesis, which provides them withimproved anatomic form and function. Due to the finite, 15° incrementsof horizontal rotation and the ability for its vertical angle correctingabutments to, therefore, be close to parallel, this system provides aset of accessory components that interface with a polyhedron on the topend of the multifunction abutment having a flat or other appropriateconfiguration at its primary indicium site. Therefore, when the primaryindicium of the multi-function abutment, which has been ideallypositioned so that the screw access hole approximates the center of theocclusal table, receives a cylinder or other polyhedron, it has apositive “seat” while being anti-rotational. Since the receivingpolyhedron on the multifunction abutment is also tapered, theanti-rotational polygon of multiple units does not interfere with theseating of several connecting cylinders because of a parallelism issue.With the existing screw retaining devices, the seating of cylinders is avery cumbersome process, since they are designed without any positiveseat to avoid parallelism issues and, therefore, pivot when beingseated. This system also has a bonding sleeve that can be seated overeither the multifunction abutment's cylinder or any cylinder used withany other implant abutment and provides a stronger union between thescrew-retained prosthesis and the cylinder as they are connected by anadhesive. The bonding sleeve can also be used during bite registrationprocedures as a vertical stop and can also prevent wax from entering thescrew access hole and contaminating the threads. In addition, it can bea very effective vertical stop when converting a denture to transitionalscrew retained prosthesis during the immediate load full arch procedure.After the necessary steps are completed, the vertical stop can then becut flush with the denture. The finite increments of rotation and thebonding sleeve provide a dramatic improvement in technique for theimmediate insertion of 4 or more implants and the conversion of thepatient's denture to a screw retained transitional prosthesis in asingle day procedure. It dramatically cuts down on wasted “chair time”,while increasing predictability of achieving the desired results. Themultifunction abutments can come as preformed, millable, pressable, andcastable versions, the latter three of which can be fabricated with asignificant reduction of bulky contours.

The Universal Impression, 3D Imaging, and Milling System

The Universal Impression, 3D Imaging, and Milling System (see FIGS.70-92 ) discloses a set of devices for identifying and registering theprimary indicium of a universal aligning adaptor, after it has beenrotated into a predetermined, preferred position to compensate for indexmisalignment. All of the registration devices can be usedinterchangeably over the same adaptor at its primary indicium referencepoint, since they all share the same internal configuration and indiciawhich engages the index of the adaptor or an indexed healing cap withthe same indexing. The subset of registration devices includes animpression post, an intraoral or bench scanning post, and a CT scanimaging post, all of which have primary and secondary indicia.

The external configuration of the impression post is structured to beeasily impressed and seated inside of the resulting impression. Incertain embodiments, it can have an external flat overlying the internalflat which, in turn, is over the primary indicium such that itfacilitates the seating of the impression post on the adaptor or theuniversal aligning post inside of it when it is in the impression. As analternative, the operator may choose to use a registration coping, whichhas an internal and external primary indicium which guides it into placeand provides an absolute seat for the analog as its primary indicium isaligned with that of the registration coping, which prevents operatorerror. Multiple registration copings can be connected with bonding rodsfor additional stability.

The external configurations of the intraoral and bench scan post and theCT scan imaging post are designed to facilitate the 3D imaging performedin each case. When possible, the external configurations of the scanningand the CT scan imaging posts are the same so that the images can bemerged. In one embodiment, the external configurations have one or morepolyhedrons that can be easily identified in the scans/imaging process.The scanning post is composed of a material that can easily be picked upby the scanner, while the scan imaging post is composed of any type ofmaterial that will avoid X-ray scatter. The identifying polyhedrons canbe enhanced in each version.

Because the scan post for the intraoral or bench scan and the scan postfor the CBCT scan are both registering the primary indicium of theuniversal aligning adaptor, and because their own primary indicia are inidentical relative positions, their scan images can be merged. Thisallows the images of the implant adaptor to soft tissue and the implantadaptor to hard tissue (bone, implant, and teeth) to be combined. As aresult, the final abutment and prosthetic devices can be fabricated fromthese scans. The Universal System can facilitate the milling ofabutments and overlying prosthetic devices by including its scan code ofthe automated and/or interactive clinical and digital protocol scan codeinto the milling device codes and controls of the milling softwareprogram. Specifically, the protocol by either manual rotation or byautorotation realigns a virtual abutment into an ideal position. Theprepositioned milled abutment can then be fabricated off of the datafrom such rotation, thereby reducing the need for additional milling ofnon-parallel side, which preserves the emergence profile.

The Method of Aligning, Synchronizing, Referencing, and Forming a Set ofUniversal Abutments

The Method of Aligning, Synchronizing, Referencing, and Forming a Set ofUniversal Abutments discloses multiple methods for restoring implantsusing the universal aligning adaptor in combination with an automatedand/or interactive clinical and/or digital protocol to realign andsynchronize abutments into preferred positions utilizing their primaryand secondary indicia. The following descriptions summarize the methodsthat are described. The first technique encompasses a unique indexedhealing cap that registers the adaptor/implant indexing, its preformedgingival architecture, and the gingival contours overlying the implant.It has an external or internal index on its top end, which is a replicaof the underlying index of the adaptor such that its primary indicium issituated at the center point of the healing cap, when it has beensituated in a preferred, predetermined position. In another embodiment,the indexed healing cap is connected to the implant and has an externalor internal index, which, in this case, replicates the implant's index.An impression can also be taken directly on a multifunction abutmentafter it has been rotated into a preferred position such that theprimary indicium of the abutment and, therefore, the impression post isin its preferred position. Secondly, a preformed abutment that has aprimary indicium at its center point is rotated such that it is alignedwhen it is ideally situated, synchronized, and referenced to identifyand register its preferred position. Third, the methods of using theuniversal aligning adaptor in combination with preformed healing capshaving specific gingival contours at the exposure of the implant fortissue training, which is followed by an impression that registers thatgeometry, and then a final abutment whose base is a replica of theoriginal healing cap. Fourth, a method of facilitating the immediateload of four or more implants after their insertion, wherein theuniversal aligning adaptor, in combination with the multifunctionabutment, simplifies the process due to the finite increments ofrotation that are 15° or less for all implants and the use of theuniversal aligning analog to compensate for any further horizontal anglecorrection. Fifth, the method of converting any preexisting abutment toa universal aligning abutment, by adding primary and secondary indiciaincrements to the abutment, along with an automated and/or interactiveclinical and/or digital protocol. Finally, the use of the ideal implanthaving a primary indicium that is referenced for its restoration and theuse of the nonagon implant index within that context that has a specificvertex as its primary indicium.

Method of Aligning, Synchronizing, 3D Imaging, and Milling ProstheticComponents and Devices

Method of Aligning, Synchronizing, 3D Imaging, and Milling ProstheticComponents and Devices describes various methods of translating theautomated and/or interactive clinical protocol to a digital protocolsuch that a virtual adaptor can be rotated in a software program byusing the scan code of the automated and/or interactive clinical anddigital protocol, which is incorporated into the milling device codesand controls of the milling software program. The second methoddescribes the creation of milled abutments for a screw borne prosthesisas the preferred abutments instead of preformed ones. The next methoddescribes the creation of milled abutments as crown and bridge abutmentssuch that they have an ideal anatomic form regardless of the implant'sindex misalignment, as they are being rotated before being milled. Thefourth method shows how the virtual universal aligning adaptor, incombination with the automated and/or interactive clinical and/ordigital protocol, can be used in a CT scan software program to create amilled abutment or set of abutments with ideal anatomic form andfunction, along with a milled coping or framework. The next methoddiscloses how the universal system merges intraoral or bench scan imageswith those of a CT scan. Finally, the last method demonstrates how totranslate the data from a previously rotated, preformed abutment to avirtual milled abutment prior to milling the physical one.

The Universal Aligning, Synchronizing Implant

The Universal Aligning, Synchronizing Implant discloses an implanthaving an internal or external index with “n” regular sides and aprimary indicium reference point from which all of its prostheticcomponentry having co-operable indices are synchronized. Its co-operablecomponentry can also be rotated in combination with an adaptor using anautomated and/or interactive clinical and digital protocol to ideallyposition them in finite increments, when the implant has not beeninserted such that its primary indicium is bisecting the ridge of thejaw at a 90° angle where the center point of the projected abutment willbe located.

At least one embodiment provides a nonagon implant having an internal orexternal index that is a regular 9 sided polygon having 9 equal sidesand 9 vertexes with 9 lines of symmetry each of which extend from aparticular vertex 180° to an opposing side, with only one of the 9vertexes having a symmetry line that bisects its opposing side, and,therefore, serves as the index's primary indicium reference point forthe ideal insertion of the implant and for aligning and synchronizingall prosthetic componentry having co-operable indices.

While each inventions disclosed enhances the universal system, many ofthem are to be considered on their own merits as stand-alone products,as well, since they can be used on any implant without a universalaligning adaptor. They are not limited to the preferred embodimentspresented in these patent applications. While most of the innovationsare based upon the universal aligning adaptor described in this patentapplication, several of them are applicable to any type of adaptorseated on a dental implant or to an implant without an interfacingadaptor, such as the indexed healing cap described above.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated herein and form partof the specification, illustrate the present invention and, togetherwith the description, further serve to explain the principles of theinvention and to enable a person skilled in the relevant art(s) to makeand use the invention.

FIGS. 1-8 show various aspects of the universal adaptor/abutmentassembly.

FIGS. 9A-C and 10A-C are frontal views showing two methods of connectingan adaptor and abutment assembly to an implant.

FIGS. 11A-C show the predetermined counter clockwise rotation around thevertical axis of the implant such that the adaptor's primary indicia isone stop under the abutment's first secondary indicia followed by theadaptor/abutment assembly to realign the abutment so that it is within amaximal 7.5° deviation from the ideal direction.

FIGS. 12A-23 illustrate some of the possible combinations of adaptor andimplant indexes to create ideal horizontal rotations.

FIGS. 24A-J show the adaptor/abutment predetermined rotationcombinations using their primary and secondary indicia to optimallysituate the abutment such that it is within a maximal 7.5° deviationfrom the ideal position.

FIGS. 25A-F illustrate different embodiments of the universal abutment.

FIGS. 26A-C illustrate how a surgeon or restorative dentist can rotatean abutment about the universal adaptor to achieve the proper aestheticalignment of the abutment.

FIGS. 27-31 provide several examples of asymmetric and symmetric contourhealing caps and abutments that can be used in combination withuniversal aligning adaptors so that they are ideally positioned.

FIGS. 32-39B illustrate several configurations of universal healing capsthat are rotated into ideal positions to establish tissue training someof which serve as platforms to receive impression and scanning posts.

FIGS. 40-46B disclose paralleling posts in combination with adaptorsused for implant site preparation and guided tissue punches that make aprecise cut of the implant's overlying gingiva.

FIGS. 47-48 illustrate the use of a previously rotated healing cap as asurgical template to initiate tissue training.

FIGS. 49-53 disclose the universal multifunction abutment for thefabrication of any screw down prosthesis.

FIGS. 54A-55 is a frontal and side view demonstrating the rotation ofthe universal multifunction abutment and its adaptor via their primaryand secondary indicia to predetermined positions to optimally positionthe abutment.

FIGS. 56A-57B reveal the rotation of the universal multifunctionabutment to axially reposition the screw access holes.

FIGS. 58A-61 illustrate the method of realigning a misaligned universalmultifunction abutment via the primary indicium of the adaptor and itsprimary and secondary indicia to center it over the implant.

FIGS. 62-67 show the limits of rotating anterior and posterior verticalangle correcting abutments around misaligned hexagon indexes withoutrealigning and situating abutment center lines using aligning adaptorsvs. the results achieved when aligning adaptors are used with theabutments.

FIGS. 68-69C show the compounding effects of restoring misaligned,angled implants around the curve of the arch.

FIGS. 70-83 reveal six methods of taking impressions with the universalimpression system.

FIGS. 84-92 reveal universal scanning posts for taking an intraoral orbench scan or CBCT scan of any implant.

FIGS. 93-96 display a universal aligning analog for use in any labfabricated model or with any CT scan generated model which is used forthe fabrication of any screw borne or cement on prosthesis.

FIGS. 97A-D discloses a carrier/aligning tool.

FIGS. 98-102 reveal the nonagon implant which has a nine sided indexwith a vertex or situating primary indicium, and, which, in combinationwith a universal aligning adaptor, provides an absolute 5° horizontalrotation of all prosthetic components until they approach the centerline.

FIG. 103 is a functional block diagram depicting a system for producingdental fixtures according to various embodiments of the disclosure.

FIG. 104 is a flow chart depicting a process of producing dentalfixtures according to various embodiments of the disclosure.

FIG. 105 is a flow chart depicting a process of producing dentalfixtures according to various embodiments of the disclosure.

FIG. 106 is a flow chart depicting a process of producing dentalfixtures according to various embodiments of the disclosure.

FIG. 107 is a flow chart depicting a process of producing dentalfixtures according to various embodiments of the disclosure.

FIG. 108 is an example computer system useful for implementing variousembodiments.

The features and advantages of the present invention will become moreapparent from the detailed description set forth below when taken inconjunction with the drawings, in which like reference charactersidentify corresponding elements throughout. In the drawings, likereference numbers generally indicate identical, functionally similar,and/or structurally similar elements.

For convenience, the description numbers have been grouped according tothe part to which they are affixed, but have also been organizedaccording to their function. For example, 121 is a primary indicium onthe adaptor, whereas the primary indicia on other components also end in21 (321, abutment; 421, healing cap; 521, multifunction abutment; 621,impression post; 721, scanning post; 921, nonagon implant). Thecategories are as follows: 10 implant; 100 adaptor; 200 fixation screw;300 crown and bridge abutment; 400 healing cap; 500 multifunctionabutment; 600 impression post; 700 scanning post; 800 auxiliarycomponentry; and 900 the nonagon implant. The reader can determine fromthe first digit, which type of component he or she is observing. At theend of this section, the reader will find a complete catalogue of thelabels used in these drawings, along with a brief description.

DETAILED DESCRIPTION OF THE DRAWINGS

It is noted that references in the specification to “one embodiment,”“an embodiment,” “an example embodiment,” etc., indicate that theembodiment described may include a particular feature, structure, orcharacteristic, but every embodiment may not necessarily include theparticular feature, structure, or characteristic. Moreover, such phrasesare not necessarily referring to the same embodiment. Further, when aparticular feature, structure, or characteristic is described inconnection with an embodiment, it is submitted that it is within theknowledge of one skilled in the art to effect such feature, structure,or characteristic in connection with other embodiments whether or notexplicitly described.

The embodiments described in the following “detailed description of thedrawings” covers all aspects of clinical and digital implantrestoration, since the prosthetic components are available as mechanicaland “virtual” components with the latter utilized in a software programfor fabricating final abutments and/or devices. For example a universalaligning adaptor can be used according to an automated and/orinteractive clinical and/or digital protocol to be rotated around animplant to a predetermined, preferred position, and the virtual versionof the adaptor (a digital adaptor facsimile) can be used in a softwareprogram to effect that very same rotation.

It is understood that the section headings used in the presentapplication are merely intended to orient the reader to various aspectsof the disclosed Adaptor System. The section headings are not intendedto limit the disclosed and claimed inventions. Similarly, the sectionheadings are not intended to suggest that materials, features, aspects,methods, or procedures described in one section do not apply in anothersection. Therefore, descriptions of materials, features, aspects,methods or procedures described in one section are intended to apply toother sections as it would be understood to those skilled in the art.

I. Rotation, Alignment, and Synchronization

FIGS. 1-3 illustrate one embodiment of a universal aligningadaptor/abutment assembly for use with restoring dental implants withcrowns, such as with the Universal Contour Abutment System and Method ofAligning, Synchronizing, Referencing, and Forming a Set of UniversalAbutments and Method of Aligning, Synchronizing, 3D Imaging, and MillingProsthetic Components and Devices described herein.

FIG. 1 is a frontal view showing the universal aligning adaptor (100)prior to its being connected to a co-operable abutment post (300) havingprimary and secondary indicia. The universal aligning adaptor (100) isconfigured to be seated on an implant (10). There is a vast array ofpossible embodiments in addition to the examples shown in FIGS. 1-25F.In another preferred embodiment the universal aligning adaptor/abutmentassembly is used with the Universal Multifunction Abutment Systemcomponents for restoring implants with screw borne crowns, hybridprostheses, over dentures or other screw borne prostheses, which will bediscussed later (See FIGS. 49-69C).

In FIGS. 1 (frontal view) and 2 (side elevation view), the implant (10),itself, is represented as it exists after placement in the bone. In thisexample, it has a threaded portion (12) to receive a fixation screw(200). The universal aligning adaptor (100) is seated on the implant(10) and has at one end an external stem or post (140). In certainembodiments, the universal aligning adaptor (100) is configured to fitinside the index of the implant. As depicted in FIG. 1 , the universalaligning adaptor (100) has a tripod stem (141) configured to fit insidetrichannel index (15) of the implant. In a number of other embodiments,the trichannel receptor of the implant may be replaced by a hexagon (6sided), dodecagon (12 sided), octagon (8 sided), a nonagon (9 sided)index or any other polyhedron that serves as the implant's index,depending upon the internal configuration of the implant chosen by themanufacturer, which interfaces with a universal aligning adaptor with amatching protruding index (140).

With an implant having an octagon index (24, not shown here), theadaptor could have a hexagon protrusion (112, not shown here). These arenot the only implant configurations that may be restored via theuniversal aligning adaptor, which may have many other means of varyingdimensions and of such a nature as to fit into several different typesof manufactured implants having various indexes, internalconfigurations, dimensions and internal thread diameters.

FIG. 1 shows the primary indicium of the adaptor (120) and the primary(321) and secondary (325) indicia of the abutment, which providedirected rotation of the adaptor about the abutment, which aligns andsynchronizes all co-operable componentry. The abutment (300) can beconnected to the adaptor (100) such that the primary indicium of theadaptor (120, 121) is positioned under one of the primary (321) orsecondary (325) indicia of the abutment. The alignment of the primaryindicium of the adaptor (120, 121) relative to the primary (321) orsecondary (325) indicia of the abutment provides the surgeon,restorative dentist, or technician (herein referred to as the“operator”) with an automated, interactive clinical and/or digitalprotocol to realign the abutment to an ideal position after the rotationof the combined assembly. The primary indicium of the aligning adaptor(120, 121) therein serves as a reference point for the identificationand registration of the mutual geometry of all assembly elements for thefabrication of final prosthetic components and/or devices by anautomated and/or interactive clinical and/or digital protocol.

The abutment can have gingival contours, such as standard gingivalcontour (330), scalloped collar gingival contour (331), anterior shapedgingival collar, medium posterior gingival shaped collar, largeposterior shaped gingival collar, maxillary contour shaped gingivalcollar, mandibular contour shaped gingival collar, or cylindrical collar(337). It is understood that the shape of the gingival contour dependson the intended position of the adaptor/prosthesis. The gingival collaralso can have a depth extension (338) depending again on the intendedposition of the adaptor/prosthesis. Indeed, it is understood thatgingival depth can vary from one patient to the next and also from onetooth position to the next within a given patient. Therefore, it iscontemplated that one can design custom gingival collar depths andshapes to respond to these differences in gingival depths and shapes.

In the clinical version of the system, the alignment of the primaryindicia of the adaptor relative to the primary or secondary indicia ofthe abutment is considered to be “automated” in that these relativepositions instantly direct the operator towards rotating the abutment toits ultimate orientation for ideal position within the dentalprosthesis. The indicia are also “interactive” in that the operator mayelect to override the predetermined orientation by further rotating theadaptor about the abutment. In addition, the automated and interactivityfeatures of the present system can be used with a milling softwareprogram such that the program utilizes the indicia information toautorotate the abutments to predetermined positions or to modify thosepositions. In the clinical version of the system, the surgeon orrestorative dentist would have access to a kit or library of existingcomponents which would allow him or her to complete the “loading” of theimplant using the components and procedures of the present application.In the digital version of the system, it is contemplated that, theindicia information of the universal scan post/adaptor/abutment would beincorporated into a milling software program such that the orientationinformation provided by the indicia could be used to better enhance thefunctionality of abutment and prosthesis fabrication by acomputer-driven milling program, in contrast to the present state of theart. The technician would have access to that library of components.

Throughout the present application, reference is made the making ofprosthetic components, such as abutments and the like, and finalrestorative components by “milling”. It is understood herein that themilling refers to any computer-driven process for making prostheticcomponents or devices. Such methods include 3D printing techniques,milling, etc.

In at least certain embodiments, the primary indicium of the universalaligning adaptor is a sphere of appropriate shape and size to intimatelycontact one of the primary or secondary indicia of the abutment post,which are recessed spheres for a “snap” fit. In at least certainembodiments, the snap fit between the sphere of the adaptor and therecess of the abutment post can be released for disengagement. Althoughthe snap fit is exemplified through a sphere and a corresponding recess,it is understood that the snap fit can be formed through any shapedprotrusion and corresponding recess. Additionally, although the snap fitis exemplified as the male component residing on the adaptor and thefemale component residing on the abutment, the snap fit embodiments canalso be configured such that the male component is on the abutment andthe female component is on the adaptor.

Once realignment is completed, the assembly can be affixed to theimplant (10) by a fixation screw (200), which, in this example, extendsthrough the octagon stud (111) at the top at the screw access channel(151) and the tripod external post (141) at the bottom, which interfaceswith the trichannel (21) passage of the implant.

The rotation shown in FIGS. 1, 11A-C, 24A-K, 32-39B, 54A-C, 55, 54A-58C,59, 60A-C, 61, 69A-C, and 88-96 can be preformed either clinically withphysical components or virtually in a software program, as describedabove, by conveying its scan code to a designing program for preplanningor to the milling device codes of a milling program as described below.

The adaptor has many embodiments below its flange or collar (130),which, at its top end, can be the same size as the head of the implantor can be one of a different size such as when the surgeon orrestorative dentist creates platform switching by choosing an adaptorhaving a base diameter that is smaller or larger than the interfacingimplant head. It is composed of any suitable restorative material suchas but not limited to titanium, titanium alloy, either one of thosematerials coated with nitrile or any other material for esthetics orfunction, zirconia, a ceramic, or other suitable material.

With the embodiment shown in FIGS. 1-3 , the base of the abutment (300)is configured to seat upon the universal aligning adaptor's (100) studor projection (111), which is at the incisal or top end of the adaptor,wherein the stud or projection has a conforming diameter with the femalereceiving polygon (internal interfacing index) of the abutment. The studor projection (111) upon which the abutment is seated is not limited toan octagon (as shown in FIG. 1 ) or hexagon, but can have the shape ofany suitable polyhedron. The base of the abutment can come in a varietyof standardized sizes, shapes and contours. In at least certainembodiments, the abutment base is customizable.

In at least certain embodiments, the stud (111) of the adaptor allows aprecise interdigitation with the abutment along with the ability forthem to be rotated about each other when not connected to the implant(10). In certain embodiments, the stud and abutment can be rotated abouteach other until the primary indicium of the adaptor (120) is alignedvia a predetermined rotation under one of the primary (321) andsecondary (325) indicia of the abutment, after which, they are combinedwith the implant. In certain embodiments, the adaptor/abutment assemblycan be rotated in 15° or 7.5° increments, which results in a maximal7.5° or 3.75° deviation from the ideal position, depending upon whetherthe internal interfacing index of the abutment is an octagon (361) asshown in FIG. 4 or a hexadecagon (362) as shown in FIG. 5 . Explained ina slightly different way, the adaptor/abutment assembly in certain ofthe described embodiments can be rotated in 15° increments, which meansto the surgeon or restorative dentist that the assembly could be in amaximal 7.5° deviation in the clockwise or counterclockwise direction.In other embodiments, the adaptor/abutment assembly can be rotated 7.5°increments, which means to the surgeon or restorative dentist that theassembly could be in a maximal 3.75° deviation in the clockwise orcounterclockwise direction. Other embodiments allow for even smallerdegrees of rotation than 15° or 7.5° and therefore in the clockwise andcounterclockwise direction, these embodiments provide even less degreesof deviation to the surgeon or restorative dentist.

It is understood that the selected primary or secondary indicia can varyby rotational direction (clockwise vs. counter clockwise) and by stopnumber (e.g., a, b, c or A, B, C) and can be different for each implantindex (hexagon vs. trichannel vs. octagon, etc.) to establish the finiteincrements of rotation. These indicia increments (122) are ideallycorrelated to the underlying implant index and/or adaptor index.Therefore, to the extent that an adaptor/implant combination is designedto achieve 15° increments of rotation, each indicia increment on theadaptor visually represents that increment of rotation to the surgeon,restorative dentist, or technician. Other embodiments described hereinare capable of achieving 7.5° increments or rotation and even smallerincrements of rotation. It is understood that the indicia increments(122) for such embodiment would reflect such degrees of rotation.

Tables 1-4, below, show one method of using a set of predeterminedrotation points as a part of the Universal automated and/or interactiveclinical and/or digital protocol, wherein an adaptor is rotated about anabutment prior to the two being combined into an assembly, and saidassembly is then rotated about, and seated onto, an underlying implant.The table could also be used to first rotate the adaptor to a setposition over the implant, followed by the post being rotated andinserted over the adaptor. The table columns describe the prosthesisorientations achievable by rotating an adaptor about an abutment to theindicia settings stated in the topmost row (e.g. 0, A, B, C, 180, c, b,a in Table 1), while the table rows describe the prosthesis orientationsachievable by rotating the adaptor/abutment assembly about theunderlying implant and seating said assembly at the implant stop anglesstated in the leftmost column (e.g. 0°, 120°, 240° in Table 1). Thus,the tables describe, for the particular mutual geometry of an adaptorand overlying implant device, the set of all possible prosthesisorientations achievable for given combinations of adaptor/abutmentindicia settings and assembly rotations. For example, Table 1, below,illustrates how the Universal automated and/or interactive clinicaland/or digital protocol can be used to correct for misalignment of anunderlying Tri-channel-index (three-sided) implant. By itself, thetrichannel index implant yields just three possible final prosthesisorientations: 0°, 120°, and 240°, corresponding to the three physicalimplant stop angles provided by the device. The introduction of theUniversal Aligning Adaptor with an upper index having a differentpolygonal configuration than the implant's index, however, gives rise totwenty-four possible final prosthesis orientations when the upper indexis an octagon, each obtained by a different combination ofadaptor/abutment indicia setting and assembly rotation. For instance,when the adaptor is rotated about the abutment to indicia setting “C”,and the combined assembly is then rotated 240° and seated onto theunderlying implant, the net result is a 15° correction of the finalprosthesis orientation towards the buccal. Likewise, the selections ofindicia setting “c” and a 120° combined assembly rotation also producesa net 15° correction of the final prosthesis orientation, but towardsthe lingual.

The various combinations are not arbitrary—they are well defined giventhe mutual geometry of the adaptor and underlying implant—and cover afull 360° in 15° increments, however, as seen in the tables, they arenot monotonic. Nonetheless, there is little or no work to be done todetermine the optimal pairing: by employing the Universal automatedand/or interactive clinical and/or digital protocol, the practitionerneed only look up the desired final prosthesis orientation in theappropriate table, configure the adaptor/abutment assembly at thedesignated indicia setting, and then rotate the combined assembly to thedesignated implant stop angle. The result is an automatic correction forthe misalignment of the underlying implant, and positioning of the finalprosthesis at an optimal orientation. Of course, after fitting, thepractitioner is free to choose a different pairing for overridingaesthetic and/or clinical concerns, wherein the combined assembly issimply removed, the adaptor/abutment assembly is reconfigured (forexample, to indicia setting “b” instead of “C”), and finally recombinedand re-rotated to the indicated implant stop angle (here, achieving anet 30° rotation to the buccal). In essence, the Universal automatedand/or interactive clinical and/or digital protocol enables optimalpositioning of a final prosthesis, irrespective of the alignment of theunderlying implant's index, in a simple, three-step process: analyze howfar off the implant is from the surgical planning (preferred location);look up the preferred, predetermined rotation point; and rotate thephysical or virtual components. Moreover, it achieves 15° or smallerincrements of correction, such that the final prosthesis orientationwill be no more than 7.5° away from any target reference angle. In thecase of the Tri-channel-index implant, the benefit is quite clear: usingjust the implant index for rotation, a prosthesis with an intendedorientation of, for example, 85°, can only be positioned at 120°,producing an unacceptable 35° angular misalignment. With a Universaladaptor configured at indicia setting “B” and implant stop angle 0°,however, the prosthesis becomes oriented at 90°, yielding a mere 5°angular misalignment. This 85% reduction in angular misalignment isclearly superior with regard to clinical stability and aestheticacceptance.

TABLE 1 Assembly Indicia Setting for Tri-channel Implant Rotation 0 A BC 180 c b a   0°   0°  45°  90° 135° 180° 225° 270° 315° 120° 120° 165°210° 255° 300° 345°  30°  75° 240° 240° 285° 330°  15°  60° 105° 150°195°

Tables 2-5, below, show the achievable orientations for differentadaptor/abutment/implant geometric configurations. As previouslymentioned, the adaptor has independent upper and lower indexes withdifferent geometrical shapes, the lower index matching that of theimplant so that the adaptor can be seated upon it. Here, the mutualgeometries afford multiple settings which all achieve the same desiredprosthesis orientation. Table 2, below, shows four 15° rotation points(two buccal, two lingual) for the Hexagon implant, Table 3 indicateseight 15° rotation points (four buccal, four lingual) for the Dodecagonimplant, Table 4 depicts four 15° rotation points (two buccal, twolingual) for the Octagon implant with a Hexagon upper-index adaptor.Table 5, below, shows the superiority of the nonagon implant thatrotates in 5° increments, as opposed to the 15° increments of rotationfor the other implants of Tables 1-4. Therefore, although the otherembodiments of Tables 1-4 are far superior to existing implanttechnologies in that the surgeon or restorative dentist can have severalpositions to correct to 15° or less, the nonagon can routinely allow thesurgeon or restorative dentist to be within 5° of the preferred,aesthetic position and increases the number of possible positions thatallow for even 0° of misalignment. The practitioner is free to use anyof the available settings to achieve an aesthetically correct alignmentof the abutment or other prosthetic component over the underlyingimplant.

Not to belabor the point, but to make clear the power of the presentinvention, the conventional implants presently available only allow forthe coarse increments of rotation dictated by their indices and theirindices alone. Therefore, the trichannel only allows for 120° ofrotation. Likewise, the hexagon implant only allows for 60° of rotation.

The present invention establishes very fine increments of rotation in15° rotation or less and even 5° of rotation or less for the nonagonimplant.

TABLE 2 Assembly Indicia Setting for the Hexagon Implant Rotation 0 A BC 180 c b a   0°   0°  45°  90° 135° 180° 225° 270° 315°  60°  60° 105°150° 195° 240° 285° 330°  15° 120° 120° 165° 210° 255° 300° 345°  30° 75° 180° 180° 225° 270° 315°   0°  45°  90° 135° 240° 240° 285° 330° 15°  60° 105° 150° 195° 300° 300° 345°  30°  75° 120° 165° 210° 255°

TABLE 3 Assembly Indicia Setting for the Dodecagon Implant Rotation 0 AB C 180 c b a   0°   0°  45°  90° 135° 180° 225° 270° 315°  30°  30° 75° 120° 165° 210° 255° 300° 345°  60°  60° 105° 150° 195° 240° 285°330°  15°  90°  90° 135° 180° 225° 270° 315°   0°  45° 120° 120° 165°210° 255° 300° 345°  30°  75° 150° 150° 195° 240° 285° 330°  15°  60°105° 180° 180° 225° 270° 315°   0°  45°  90° 135° 210° 210° 255° 300°345°  30°  75° 120° 165° 240° 240° 285° 330°  15°  60° 105° 150° 195°270° 270° 315°   0°  45°  90° 135° 180° 225° 300° 300° 345°  30°  75°120° 165° 210° 255° 330° 330°  15°  60° 105° 150° 195° 240° 285°

TABLE 4 Assembly Indicia Setting for the Octagon Implant Rotation 0 A B180 b A   0°   0°  60° 120° 180° 240° 300°  45°  45° 105° 165° 225° 285°345°  90°  90° 150° 210° 270° 330°  30° 135° 135° 195° 255° 315°  15° 75° 180° 180° 240° 300°   0°  60° 120° 225° 225° 285° 345°  45° 105°165° 270° 270° 330°  30°  90° 150° 210° 315° 315°  15°  75° 135° 195°255°

TABLE 5 Assembly Indicia Setting Rotation 0 A B C 180 c b a   0°   0° 45°  90° 135° 180° 225° 270° 315°  40°  40°  85° 130° 175° 220° 265°310° 355°  80°  80° 125° 170° 215° 260° 305° 350°  35° 120° 120° 165°210° 255° 300° 345°  30°  75° 160° 160° 205° 250° 295° 340°  25°  70°115° 200° 200° 245° 290° 335°  20°  65° 110° 155° 240° 240° 285° 330° 15°  60° 105° 150° 195° 280° 280° 325°  10°  55° 100° 145° 190° 235°320° 320°   5°  50°  95° 140° 185° 230° 275°

In summary, these tables illustrate the use of a set of predeterminedreference points as a part of the Universal automated and/or interactiveclinical and/or digital protocol, employing a Universal Aligning Adaptorfor implants of any index to achieve reproducible increments of rotationof 15° or less. While the rotation point for the primary indicium of theadaptor is different for each, the protocols are the same, and yieldoptimally oriented final prosthesis positioning in any clinicalsituation.

The fixation screw (200) is configured to thread into the internal screwthreads of the implant (12). The shoulder of the screw head (240) isconfigured to engage an internal shoulder of the abutment (367) andthereby tighten the abutment to the adaptor by tightening the universalaligning adaptor (100)/abutment (300) assembly to the implant via thefixation screw. The fixation of the adaptor and abutment to the implantare not limited to any one screw or internal abutment configuration.After the adaptor and abutment are either first connected to each otheror after the adaptor is inserted into the implant in a predeterminedposition, and the abutment is then inserted on the adaptor with itsprimary indicium situated in an ideal position, the fixation screw canbe used to secure the abutment/adaptor complex to the implant.

The collar of the abutment tapers from the bottom end (369) at theflange to a larger, standardized size in order to more naturallyrepresent the size and shape of a natural tooth abutment at the top end.As shown in FIGS. 4 and 5 , the embodiment in this example has a femalereceiving polygon (internal interfacing index) of either an internaloctagon (361) with eight sides or a hexadecagon (362) with sixteen sideswhich is configured to engage the stud of the adaptor (111). With anabutment having an octagon receptacle (shown in FIG. 4 ), the octagonconfiguration of the stud, in combination with any implant with ahexagon (6 sides), tripod (3 sides), or dodecagon (12 sides) indexing,allows for the rotation of the post head in the horizontal plane inpredetermined 15° increments (a maximal 7.5° deviation from the idealdirection) shown in FIGS. 3A, 3B, and 3C for each of these implants.This ability to rotate in 15° increments is achieved independently ofthe implant's index while not being dependent upon the location of theoctagon in relationship to the implant's index, since there is nooffset. This horizontal rotation allows for a precise repositioning ofthe post prior to affixing it to the implant. The abutment can also beconfigured with a hexadecagon (16 sided) receptacle (shown in FIG. 5 ),which allows for the same rotation of the post head in 7.5° increments(a maximal 3.75° deviation from the ideal direction). If the implant hasan octagon index instead of a hexagon configuration, then an adaptorwith a hexagon stud is connected to an abutment with a matching hexagonor dodecagon receptacle which, therein, achieves the same horizontalrotation as noted above.

The rotation of the adaptor/abutment assembly with a nonagon (9 sided)indexed implant can occur in 5° increments, when the adaptor stud is anoctagon, which is shown and described, in detail, in FIGS. 23 and 98-102.

The head of the abutment (300) has an internal cylindrical passage (365)to receive a fixation screw (200). The fixation screw, itself, has ashank (210) and it can have an internal hex hole (230) to receive adriver. The threads (220) engage the internal threads (12) of theimplant, while the head of the screw engages the internal shoulder (367)of the post. Although exemplified as having threads (220) to secure thescrew to the implant, it is understood that other mechanisms, such as asnap fit mechanism, can be used to secure the screw (200) to the implant(12).

In at least certain embodiments, the adaptor, itself, has internalthreads (152) beginning above its collar that engage the fixation screwthreads (220) prior to seating the assembly on the implant. This canmake it easier to carry the assembly to the implant and prevents screwdroppage during the surgical procedure. The adaptor is not limited tohaving this internal thread. Additionally, the universal adaptor cancome in different shapes, sizes, configurations and contours than theones exemplified in the present figures. Because of the large variety ofdifferent adaptors, only a few of them are presented in the figureshere.

FIG. 6 depicts a 30° angle correcting anterior abutment (356) that issecured to the implant with a fixation screw (200) and receives a screwdown crown (390) that is affixed to the abutment with its own crownfixation screw (391), which is received in a channel (393) within thecrown. This channel (393) further extends into the abutment and thechannel of the crown and the channel of the abutment are configured tobe aligned with each other. At least the channel portion of the abutmentcontains a threaded section configured to mate with the threads of thecrown fixation screw. In other embodiments, at least a portion of thecrown channel is also threaded. This screw down crown is particularlyuseful with an anterior angled tooth where retrievability is important.In the context of dental prosthetic components, esthetics can be marredwhen the exit point of the fixation screw is frontally visible. Becausethis crown fixation screw is ideally positioned in a set, predictablemanner, located approximately 180° from the abutment's primary indicium,which itself has been situated in an ideal position, the fixation screwis not frontally visible.

This system provides the missing capability to routinely screwing downcrowns rather than cementing them. It provides two or more methods ofengaging that fixation screw. One such method is machined threads in themilled post. Another such method involves tubes with threads in thepatterns that become the cast pressable or other abutments made from apattern.

FIG. 7 depicts a screw down crown (390) seated on a 0°, non-angledabutment (353) such that its primary indicium and that of the adaptorare aligned (not shown), and is secured to the abutment fixation screw(200) with its own crown fixation screw (391). In this embodiment, thehead of the abutment fixation screw contains threads (392) to receivethe crown fixation screw (391).

At least one embodiment provides an assembly for use in the process ofdental restoration relevant to dental implant prosthetics a contourabutment intended for receiving a screw retained crown (FIGS. 6 and 7 )and an adaptor having co-operable indicia wherein the abutment has thegeometry of a natural tooth preparation and has internal screw threadsthat are positioned in the esthetic zone approximately 180° from theprimary indicium of the abutment after it has first been ideallysituated such that a crown, set of crowns, or bridge are receivable onthe abutment and are retained by the fixation screws that engage theabutment fixation screw threads comprising the steps of rotating anabutment to a preferred horizontal and vertical position, creating thescrew threads by milling them, setting internally threaded tubes, dietapping, or by another appropriate way at that location such that thethreads are ideally positioned in the esthetic zone and at the mostideal pitch for receiving a driver that is carrying the screw, andcreating the overlying prosthetic component with a stop for securing theprosthetic component on the abutment and affixing it with a fixationscrew that engages the internal threads.

For areas where the interocclusal distance is shorter than desired, FIG.8 provides a universal contour abutment/coping one piece combination(300) having a primary indicium (321) that is seated on the adaptor(100) such that their primary indicia (121 and 321) overly each otherand are secured together to the implant without an abutment post. Theadaptor (100) has a projection on the base away from the implant (110),i.e., a stud. The stud as described elsewhere herein can be any polygonshape, including a hexagon, an octagon, a nonagon, a dodecagon, etc. Thecoping/abutment component can come in a number of configurations and canbe composed of several different materials. For example it can be apreformed one to receive a porcelain bake, a castable one that is alsomodifiable, a pressable one, or a milled abutment and/or crown and becomposed of any suitable restorative material such as but not limited toa precious metal, semiprecious metal, zirconia, or titanium alloy. In analternate aspect of the invention, the coping/abutment component can bemanufactured from an additive manufacturing process, such asstereolithography. It can also receive a porcelain bake or be anabutment/coping/veneer that is milled from a block of porcelain,zirconia, composite or other suitable restorative material. Even thoughFIG. 8 represents a posterior coping without the veneering materialshown, it can be of any posterior or anterior tooth shape.

As shown throughout these patent application drawings, the adaptor andits prosthetic components have co-operable primary and secondary indicesthat indicate predetermined positions, which can then dictate theplacement of follow-on components in relation to the location of theprimary indicium of the adaptor. This can begin with the interimabutment or healing cap insertion, after it is rotated on the adaptoroff of the implant using the primary indicium of the adaptor (121) incombination with the primary (321) or secondary (322 and others) indiciaof the abutment and the assembly is, in turn, rotated on the implantFIGS. 9A-C, or is rotated on the adaptor after it has been first rotatedand seated on the implant as shown in FIGS. 3A-C. 324 is the thirdindicium counterclockwise rotation stop.

Additionally, the adaptor can be used on multiple implant indexes asshown in FIGS. 13-23 . Once the adaptor (100)/abutment (300) or theadaptor (100)/healing cap (400) assembly is affixed to the implant withthe fixation screw (200), the insertion of all other components such asimpression or scanning posts is dictated by the primary indicium of theadaptor (120, 121) in relation to the primary or secondary indicium ofthe abutment or healing cap after the appropriate rotations. Forexample, in FIGS. 70-92 , when the impression post (600) or the scanningpost (700) is inserted on the adaptor at its primary indicia referencepoints (120 or 121) or on the healing caps at their primary indiciareference points (411, 421), they are capturing the previouslyestablished position of the rotated abutment or healing cap (see FIGS.58A-58C, 59, 60A-60C, and 61 ) in relation to the implant's index. It isunderstood that the positioning of the impression or scan post on theadaptor is not limited by situating the primary indicia over each other,even though this may be a preferred embodiment. This is covered, indetail, in the Universal Impression, 3D Imaging, and Milling System, andthe Method of Aligning, Synchronizing, Referencing, and Forming a Set ofUniversal Abutments and Method of Aligning, Synchronizing, 3D Imaging,and Milling Prosthetic Components and Devices sections of thisapplication. In these embodiments shown throughout the “detaileddescriptions,” the primary indicium on the adaptor is a circle or anyother indicating reference mark or polyhedron on any one of the flats ofthe projection of the adaptor (120) that is chosen to be the referencepoint for positioning all other co-operable follow-on components. Asstated, in at least certain embodiments, this circle is a protrusion andthe overlying components have matching recesses. The primary andsecondary indicia are not limited to these configurations, but can beany type of referencing indicator that delineates the primary and/orsecondary indicia, and in any combination such as where one can be onthe collar of the adaptor without also having one on the post or viceversa. In certain embodiments, directly below this indicium is one onthe collar of the adaptor (121) to assist the surgeon or restorativedentist with visualizing the primary reference plane on the adaptorflat, after it is covered by the seated component. The indicium on theabutment post (321) is positioned directly at its 0° reference point ofthe adaptor which is its primary indicium (121). With vertical anglecorrecting abutments, the primary indicium of the abutment isapproximately 180° from the midpoint of the vertical angle correctingportion of the abutment. The use of the primary indicium relationship tothe vertical angle correcting portion of the abutment is not limited tothis embodiment but can be any one of a plurality of positionalrelationships between the primary indicium and the angle correctioncomponent. For example FIG. 1 shows a secondary indicium (325), which isa rotation point on the abutment, and is an example of the use of thesecondary indicia during rotation, which is described, in great detail,throughout these detailed descriptions. 326 is the second indiciumcounterclockwise rotation stop.

FIGS. 9A, B, and C illustrate the universal aligning adaptor and theabutment post first being combined by using their primary indiciafollowed by the seating of the assembly on the implant without anyrotation. The abutment post (300) has its primary indicium (321) and itssecondary indicium (322) on its collar. As depicted, the primaryindicium (321) is shown as “0”. Clockwise around the collar of the postare indices “A,” “B,” “C,” etc. (although only position “A” is visible).Counter clockwise around the collar of the post are indices “a,” “b,”“c,” etc. (although only position “a” is visible). Although depicted asa combination of capital and lowercase letters to allow the surgeon orrestorative dentist to easily visualize the position of the index, inthis example, it is understood that the indices can be represented byany combination of letters, numbers, or symbols. Also shown in FIGS. 9A,B, and C, the adaptor has one primary indicia on one flat (120) and thecollar (121). The primary indicia on the flat and/or the collar couldalso be a doublet line. There is no specific number of indicia on anyadaptor or abutment.

As shown in FIGS. 9A and 9B, the primary indicia of the abutment and theadaptor are aligned and the abutment and adaptor are combined together.In this combined configuration, the abutment/adaptor assembly is seatedon the implant and the position can be evaluated. If the abutment isseated in its preferred, aesthetically correct position, the fixationscrew (200) is inserted and the assembly is affixed to the implant. Thefixation screw can also be threaded into the internal threads of theadaptor (152) prior to seating the assembly to make it easier to carryit to the implant to prevent screw droppage. The internal threads aremerely one embodiment and do not dictate the design of the adaptor. Ifthe abutment is in an incorrect orientation, the abutment/adaptorassembly is removed from the implant and the surgeon or restorativedentist can rotate the abutment about the adaptor such that the abutmentand adaptor are aligned about a secondary indicia, i.e., indicia “a”.The process can then be repeated as needed until either the surgeon orrestorative dentist has confirmed that the abutment is in the mostaesthetically correct orientation.

FIG. 48 shows the adaptor (100) first being seated on the implant,followed by the abutment (300) being seated on the adaptor (shown inFIG. 10C) such that their primary indicia (121 and 321) line up. To theextent that the abutment is positioned in the aesthetically correctorientation, the abutment is secured to the implant with the fixationscrew. However, if the orientation is suboptimal, the abutment can beremoved from the adaptor, which is left in contact with the implant, andthe abutment can be rotated about the adaptor to the next indicia. If adifferent orientation is desired, the adaptor can also be removed androtated about the abutment with the assembly then being rotated aboutthe implant. Once the abutment is in the aesthetically correctorientation, the abutment is secured to the implant with the fixationscrew.

In another method, the adaptor can be first rotated over the implant toa predetermined position with the abutment then inserted over theadaptor in its preferred position.

FIG. 49 shows the abutment (300) being rotated 1 stop as a first step toideally situate it, such that the primary abutment indicium (321) nolonger lines up with the primary indicium of the adaptor (121), but,rather, has been rotated counter clockwise to position “a” (325). Thesingle stop rotation in this particular example represents a 15°rotation once the assembly is subsequently rotated to center theabutment over the implant, but these rotations are not limited by these15° increments (or 7.5° increments), but rather can be in any chosenpreset increments that are used in combination with an automated and/oran interactive clinical and/or digital protocol. If one rotation of 15°does not center the abutment, the assembly can be removed, the adaptorcan then be rotated to another secondary indicium of the abutment (inthis example, position “B”), and the assembly is reseated on theimplant. These steps can be repeated until the abutment is situated inan optimal position over the implant after the rotation of the assembly.Alternatively, the abutment can be rotated about the adaptor to theextent that the adaptor is in the correct orientation but it is theabutment that is misaligned.

FIG. 50 shows the adaptor/abutment assembly ready to be seated on theimplant with its flange engaging the top of the implant after beingoptimally situated to within 7.5° of the ideal position. These methodsare exactly the same for any trichannel, hexagon, dodecagon, octagon,quadragon, nonagon implant or any other implant having other type ofindex configuration, although the increments of rotation may vary,depending upon that configuration in relationship to the adaptor'sabutment engaging stud. All other components are seated in relation tothe primary indicia of the universal aligning adaptor after its rotationwith its external stem engaging the receptacle inside of the component,which establishes all of them in a set relationship to the implant'sindexing, and, thereby, reduces operator error. For example, FIGS. 70and 75, and 85A and 85B show the impression post (600) and the scanningpost (700) being seated on the implant with their primary indicia (621and 721) overlying the primary indicia of the adaptor (120), which, incombination, serve as an aligning/synchronizing mechanism wherein therepositioned abutment is precisely reproduced. FIG. 51 is a frontal viewshowing the rotation of the abutment on the adaptor with the primaryindicium of the abutment (321) and its secondary indicium (322)facilitating this rotation in relation to the primary indicia of theadaptor (120, 121), which, in this case, is a 15° rotation. The methodof rotating the abutment and its adaptor are also demonstrated in FIGS.1, 24-25F, 32-39B, 54A-55, 58A, 69A-C, and 88-96.

Even though the examples shown in FIGS. 1-23 are the crown and bridgeabutments of the universal contour abutment system, the principlespresented here are exactly the same for the screw retaining abutments ofthe universal multifunction abutment system as well, which is shown inFIGS. 49-76 .

At least one embodiment provides an assembly for use in the process ofdental restoration relevant to dental implant prosthetics comprising apreexisting abutment that is converted to an aligning, contour abutmentcomprised of an adaptor and the abutment, wherein co-operable indiciaare added to the preexisting abutment which is rotated at about andcombined the adaptor that also has co-operable indicia means (FIGS.1-11C). The co-operable indicia can include graduations for indicatingthe degree of rotation of the abutment and the adaptor relative to eachother. The co-operable indicia can include primary and secondary indiciasuch that the primary indicium of the adaptor is rotatable in relationto the primary or secondary indicium of the abutment as it is rotated toits desired predetermined position.

Certain embodiments provide a method of converting any preformedabutment of any type, size, or configuration to an aligning, rotatableabutment composed of an adaptor in association with the abutment thatare rotatable around each other via co-operable indicia that areincorporated into the abutment, which, when combined with an automatedand interactive clinical and/or digital protocol reposition the abutmentto a predetermined, preferred vertical and horizontal predeterminedposition. Rotating the adaptor and the abutment can be performed suchthat the abutment is ideally situated. Then one can either create amilled, cast, or pressed abutment with the parameters of the rotatedabutment such that it either engages the index of the adaptor with theassembly then being seated on the implant or directly engages the indexof the implant and is seated on the implant without the adaptor or usinga preformed abutment as the final abutment seated on an adaptor.

FIGS. 13-23 illustrate the insertion of the abutment on the adaptor withits flange contacting the collar of the adaptor as it is seated over itsexternal stem and the assembly on to the implant, and illustrates manyof the possible combinations of implant to adaptor indexing (right handdrawing) and abutment to adaptor indexing (left hand drawing) that areavailable when rotating the adaptor around the abutment according to theautomated and/or interactive clinical and/or digital protocol. When anabutment with an octagon internal mating configuration (361) is seatedon an octagon stud of the adaptor, it can be rotated on a trichannel(21, FIG. 13 ), hexagon (22, FIG. 14 ), or dodecagon (23, FIG. 15 )index in 15° increments, which can also be achieved with an abutmenthaving an internal hexagon configuration (363) that is seated on ahexagon stud of the adaptor over an implant with an octagon index (24,FIG. 17 ). If an abutment with a hexadecagon (16 sided) internalconfiguration (362) is seated on the octagon stud of the adaptor it canbe rotated on any implant index, for example a trichannel (21, FIG. 18), hexagon (22, FIG. 19 ), or dodecagon (23, FIG. 21 ) to achieve a 7.5°horizontal rotation. The same result can also be achieved with anabutment having an internal dodecagon configuration (364) that is seatedon a hexagon stud of the adaptor over an implant with an octagon index(24, FIG. 22 ) to also achieve a 7.5° horizontal rotation. FIG. 23illustrates an adaptor/implant index combination, wherein the implanthas an internal nonagon (9 sided index) (25) and an adaptor with anonagon projection that interfaces with it, while maintaining theprojection of the octagon stud (361) that has been described in theimplant/adaptor combinations, above. The unique nonagon implant indexhas a singular reference polyhedron or vertex that is the only one,which, when a line is drawn across the cylinder, bisects the opposingflat at a 90° angle. This vertex can be the primary indicium of thenonagon implant (920, FIGS. 98-102 ), which guides the surgeon to centerthe implant's index when inserting the fixture. In addition, the vertexcan serve as a reference point for placement of all overlyingcomponents. When the implant index is misaligned, an adaptor with anoctagon abutment engaging stud is rotated in combination with anabutment over a nonagon implant makes a consistent 5° horizontalrotation while maintaining an absolute reference relationship to theimplant's primary vertex. The Nonagon Implant index is intended for usewith any implant having any appropriate, effective external boneengaging configuration of any type. In all of these cases, the indexrelationships are not limited to specific polyhedrons of the abutmentmating index and/or the implant mating index in order to haveappropriate rotations to center components. This is shown in FIGS. 98and 99A-B and is covered, in detail, in the Nonagon Implant section ofthis application. While FIGS. 13-23 show the possible combinations thatestablish the finite increments of predetermined rotation, the finalposition of the primary indicium of the adaptor becomes the referencepoint for synchronizing all prosthetic componentry and referencing themto the adaptor according to an automated and/or an interactive clinicaland/or digital protocol.

FIG. 24 shows two methods of connecting an abutment to an implant withthe abutment's primary indicium being positioned in relation to asagittal plane that bisects the ridge of the jaw at its individualcenter point. The rotation is not limited to this specific position,since the preferred position can also be in another location toaccommodate esthetic and functional needs for the prosthesis. FIGS.24A-D show the rotation of the abutment on the adaptor, combining themsuch that the flange of the abutment (300) is seated on the collar ofthe adaptor (100) while its internal index engages the matching externalprojection of the adaptor, after rotating the assembly and inserting itonto the implant such that the abutment's primary indicium (321) isoptimally situated to within 7.5° of the ideal position, which has thecenter line of the tooth preparation bisecting the ridge. FIGS. 24E-Ishow the rotation of the adaptor over an implant into a predeterminedposition, followed by the abutment being rotated such that one of itsprimary or secondary indicia (325) are aligned with the primary indiciumof the adaptor (120, 121) until its primary indicium (321) is ideallysituated. The abutment (300) is seated over the adaptor (100) and theassembly is secured to the implant. FIG. 24I shows the rotation of a 0°abutment such that the tooth preparation and gingival contour areoptimally situated over the implant as dictated by the protocol and theindicia, and FIG. 24J shows the rotation of a 30° vertical anglecorrecting abutment to achieve the same result.

The following descriptions provide the details of each drawing. In theembodiment in FIG. 24A, the abutment (300) is being counter rotated(counter clockwise) one stop to position “a” (325) such that it ispositioned over the primary indicium (120, 121) of the adaptor, and inFIG. 24B the adaptor/abutment assembly is then being rotated in aclockwise direction for ideal placement of its tooth preparation andgingival contour. FIG. 24C depicts the rotated assembly having beeninserted onto the implant with its engaging stud engaging the implantindex (not shown), such that the abutment's primary indicium (321) isoptimally situated over the implant, while the adaptor's primaryindicium (121) has been relocated clockwise to the abutment's firstsecondary indicium (325). FIG. 24D shows the tooth preparation optimallysituated after the rotations are completed.

FIGS. 24E-61 show the rotation and situation of the abutment by firstrotating the adaptor. In FIG. 24E, the adaptor is first being rotatedclockwise to a predetermined position and is then inserted in theimplant as shown in FIG. 24F. In FIG. 24G, the abutment (300) is thenrotated in a counterclockwise direction such that its primary indicium(321) is ideally situated, with it then being seated on the implant asshown in FIG. 24H. Once again, FIG. 24I shows the tooth preparationshaving been rotated into ideal, situated positions.

FIGS. 25A-F show the repositioning of a tooth preparation (373, 372) andasymmetric gingival contour (331) in a proper position over the implantvia the technique shown in FIGS. 24A-D. FIGS. 25A and B show theabutment's tooth preparation (373) with its chamfer (372) and itsgingival contour (331) from a frontal view and a slightly rotated view,after the abutment is rotated counter clockwise one stop to its firstsecondary indicium position (325), (a), which, in this embodiment, is a45° counter clockwise rotation. FIG. 25C shows the abutment beingconnected to the adaptor at that rotation point such that the secondaryindicium (325) is lined up over the adaptor's primary indicia (120,121). 25D shows the adaptor/abutment assembly then being rotated overthe implant such that the abutment's primary indicium, 321, is optimallysituated over the implant which, in this example, positions it to theright of the adaptor's primary indicium (121). FIG. 25E shows therotated assembly of abutment (300) and adaptor (100) being inserted inthe implant (10) with the abutment's primary indicium (321) optimallysituated over it. And FIG. 25F shows the assembly (300/200) having beeninserted into the implant (10) in the optimally situated position. This“optimally situated” position may not have its final position exactly atthe 0° line of the center axis, but will be located 7.5° or less fromthat position, which is clinically imperceptible in relation to a 360°rotation, and is determined by the degree of the misalignment of theimplant's index during its insertion. The principles shown above forFIG. 6 can be used in exactly the same way for any type of abutment,including the universal multifunction abutment, which is shown in FIGS.49-69C.

In certain embodiments, the polygonal structure at top end of theadaptor is an octagon stud and the bottom end of the adaptor is ahexagon, tripod, dodecagon or other configuration wherein the number ofpolygonal sides of the implant engaging polyhedron is a multiple of 3and the contour or multifunction abutment have an octagon or hexadecagonreceptacle that engages the octagon stud of the adaptor such that therelative angular position of the adaptor to the contour or multifunctionabutment followed by their assembly to the implant results in net 15°increments of horizontal rotation when the engaging receptacle of theabutment is an octagon or results in net 7.5° increments of horizontalrotation when the engaging receptacle of the abutment is a hexadecagon.

In other embodiments, the polygonal structure at the top end of theadaptor is a hexagon stud and the bottom end of the adaptor is anoctagon or other configuration wherein the number of polygonal sides isa multiple of 8 and the contour or multifunction abutment have a hexagonor dodecagon receptacle that engages the hexagon stud of the adaptorsuch that the relative angular position of the adaptor to the contour ormultifunction abutment followed by their assembly to the implant resultsin net 15° or 7.5° increments of horizontal rotation when the engagingreceptacle of the abutment is an octagon or results in net 7.5° or 3.75°increments of horizontal rotation when the engaging receptacle of theabutment is a hexadecagon.

The polygonal structure at the top end of the adaptor can also be anonagon stud and the bottom end of the adaptor a quadragon. In suchembodiments, the prosthetic component has an nonagon receptacle thatengages the nonagon stud of the adaptor such that the relative angularposition of the adaptor to the prosthetic component followed by theirassembly to the implant results in net 10° increments of horizontalrotation when engaging the receptacle of the prosthetic component.

When these rotations are performed to align the adaptor's primaryindicium in relation to a specific primary or secondary indicium of theabutment such that the abutment's primary indicium is ideally situated,and when the registration devices are synchronized to the adaptor's orindexed healing cap's primary indicia, then the impression or intraoral,bench, or cone beam (CBCT) scan techniques are simplified andconsistent. In addition, when this technique is performed prior to theimpression or scan, then the milled, pressed, and/or cast abutment willhave a more natural emergence profile and ideal positioning, regardlessof the coarseness of the implant's rotation increments (trichannel at120° vs. a hexagon at 60°), etc., and the degree of misalignment. Oncethe abutment has been ideally positioned, the pertinent data such aslocation of the adaptor's primary indicium in the vertical axis ofrotation, the type of abutment at that “tooth” position, the desiredvertical angle correction of the abutment, the identification of theprimary or secondary indicium that was chosen to ideally situate theabutment, the desired gingival architecture, and other pertinent dataare conveyed to the milling program's milling device codes to create animproved abutment. Of course, with the Universal System's scan codebeing conveyed to milling device codes of the program, the millingprocess becomes automated, but it can also be interactive in that thetechnician can manually manipulate the virtual components. Of course, acast or pressed abutment is fabricated in the same manner by realigningand preparing an abutment pattern.

In FIG. 26A, it is shown how a surgeon or restorative dentist couldrotate an abutment about an adaptor to achieve aesthetic alignment ofthe abutment. For example, using the automated and/or interactiveclinical protocol, the surgeon or restorative dentist can determine theextent that the implant index is out of proper aesthetic alignment.Using the universal adaptor, the surgeon or restorative dentist canrotate an abutment about the adaptor to the correct indicia to achieveproper realignment of the abutment relative to the proper aestheticangle. The rotation can be in the clockwise or counterclockwisedirection depending on the orientation of the underlying implant.

FIG. 26B shows how the abutment would be out of proper orientation if itwere implanted in convention manner and FIG. 26C shows how the universaladaptor and clinical protocol allow for the simple reorientation of anabutment.

II. The Universal Abutment Systems' Common Features (FIGS. 1-96 )

The Universal Contour Abutment System illustrated in FIGS. 1-39B and theUniversal Multifunction Abutment System shown in FIGS. 49-69, 93-96 aretwo abutment systems that, in combination with the Universal AligningAdaptor System are used to restore dental implants. The UniversalContour Abutment System is used for the restoration of dental implantswith traditional “crown and bridge” abutments and their overlayingcement-on or screw retained crowns, sets of splinted crowns, or bridges,whereas the Universal Multifunction Abutment System is used whenrestoring implants with any screw borne prosthesis in an area of the jawwhich could be receiving a removable appliance. It either replaces theremovable appliance with a screw retained (fixed) hybrid denture orupgrades the removable denture or partial denture with a screw borneoverdenture prosthesis. In addition, due to the versatility of theUniversal Multifunction System in those areas that emanates fromdecoupling the abutments' dependence upon the coarse increments ofrotation of their implants and replacing them with the finite incrementsof rotation (15° or less) provided by the Universal System, theabutments of the Universal Multifunction Abutment System can also beused for creating screw retained crowns, a set of crowns, or bridgewithout any flange. In other words, where appropriate, a full denturecan even be replaced with a full set of screw retained crowns (nodenture flanges) on the same day that the implants are inserted.

As used herein, an “ideally situated” contour abutment refers to thespecific alignment which yields a tooth preparation as straight up andparallel to other abutments as possible, for proper aesthetics andfunction. An “ideally situated” multifunction abutment, however, is onein which the fixation mechanisms are positioned as close as possible tothe center of the occlusal table of the replacement tooth overlaying theimplant, which, in certain embodiments, focuses on the alignment andpositioning of screw access holes for proper aesthetics and function.Although the present application uses the same “ideal alignment”, “idealsituation” and/or “ideally situated” terms when discussing both contourand multifunction abutments, it is understood that, based on thedistinct underlying purposes of the abutment types, these terms havedifferent meanings with respect to the definition of “ideal” as itrelates to criteria for preferred positioning. A surgeon or restorativedentist would necessarily understand the difference in usage of thisterminology, as it applies to the classes of abutment componentry.

All types of abutments can be rotated into position over a universalaligning adaptor such that the abutment is situated in an ideal positionin relation to the implant's index as needed. From this ideal position,an impression or scan can be performed with a crown or other prostheticdevice then being fabricated to fit on it.

All abutments can be fabricated out of a variety of restorativematerials and techniques. In at least certain embodiments, a castableabutment is rotated into position over a universal aligning adaptor suchthat the abutment is situated in an ideal position in relation to theimplant's index and is prepared as needed such that a final castabutment for engaging the adaptor's index is fabricated. The assemblycan then be inserted on the implant with its primary indicium in thesame preferred position, which can then receive a crown or otherprosthetic device.

In certain embodiments, a titanium, zirconia, or other preformed,prepable abutment can be rotated over an adaptor and prepped with thecombined adaptor/abutment assembly then being affixed to the implant.

In certain embodiments, a castable abutment composed of a castablematerial suitable for casting abutments is rotated into position over acast-to adaptor which is also composed of a suitable castable materialsuch that the abutment is rotated to an ideal position in relation tothe implant's index. In this position, the abutment can be affixed tothe cast-to adaptor. The abutment and adaptor can then be cast as asingle piece, final abutment for engaging the implant's index without aninterfacing adaptor, and is then inserted on the implant. A crown orother prosthetic device is seated on this abutment.

In certain embodiments, a zirconia abutment is rotated into positionover a universal aligning zirconia adaptor, affixed to the adaptor,prepared as needed as a final abutment with the analog being directlyinserted on the implant which then receives a crown or other prostheticdevice. The zirconia abutment and the zirconia can be fused together tobecome a single abutment.

In certain embodiments, a pressable abutment composed of a ceramic orother pressable material suitable for pressing abutments is rotated intoposition over an adaptor which is also composed of a ceramic, Zirconiaor other suitable pressable material such that the abutment is rotatedto an ideal position in relation to the implant's index. In thisposition, the abutment can be affixed to the pressable adaptor. Theabutment can then be pressed as a single piece, final abutment forengaging the implant's index without an interfacing adaptor, and is theninserted on the implant. A crown or other prosthetic device is seated onthis abutment. The abutment could also be pressed to an adaptor composedof a dissimilar material that would accept the pressable porcelain orother suitable material without distorting.

A milled abutment comprised of any suitable restorative material can bevirtually rotated into an ideal position over an adaptor using theuniversal aligning system's automated and interactive clinical protocolin a milling software program to eliminate mesial-distal misalignmentprior to milling the abutment and then milled either as a single piece,final abutment for insertion on the implant as it engages its indexwithout an interfacing adaptor or is milled to be receivable on theadaptor with the assembly then being inserted on the implant with acrown or other prosthetic device being seated upon it. In an alternateaspect of the invention, the abutment can be manufactured from anadditive manufacturing process, such as stereolithography or 3Dprinting.

All abutments are decoupled from their implant indexes and are recoupledto adaptors, and, therefore, have the ability to be rotated as needed in15° or less increments. In certain embodiments, the adaptor and theabutment can have dissimilar polygonal structures and co-operableindicia such that the rotation of the adaptor and abutment results inincrements of horizontal rotational adjustment over the implant to apredetermined position. The polygonal structure at the top end of theadaptor can be an octagon stud and the end of the adaptor can be ahexagon, tripod, dodecagon or other configuration wherein the number ofpolygonal sides is a multiple of 3 and the abutment has an octagon orhexadecagon receptacle that engages the octagon stud of the adaptor suchthat adjusting the relative angular position of the adaptor to theabutment followed by their assembly to the implant results in net 15°increments of horizontal rotation when the engaging receptacle of theabutment is an octagon or results in net 7.5° increments of horizontalrotation when the engaging receptacle of the abutment is a hexadecagon.

In other embodiments, the polygonal structure at the top end of theadaptor is a hexagon stud and the end of the adaptor is an octagon orother configuration wherein the number of polygonal sides is a multipleof 8 and the abutment has a hexagon or dodecagon receptacle that engagesthe hexagon stud of the adaptor such that adjusting the relative angularposition of the adaptor to the abutment followed by their assembly tothe implant results in net 15° increments of horizontal rotation whenthe engaging receptacle of the abutment is an octagon or results in net7.5° increments of horizontal rotation when the engaging receptacle ofthe abutment is a hexadecagon.

In other embodiments, the polygonal structure at the top end of theadaptor is a nonagon stud and the bottom end of the adaptor is aquadragon and the prosthetic component has an nonagon receptacle thatengages the nonagon stud of the adaptor such that adjusting the relativeangular position of the adaptor to the prosthetic component followed bytheir assembly to the implant results in net 10° increments ofhorizontal rotation when engaging the receptacle of the prostheticcomponent.

In certain embodiments, the co-operable indicia include graduatedreference points and/or a mechanism of primary and secondary indiciathat establish the rotation and synchronization points.

In certain embodiments, the co-operable indicia include graduations forindicating the degree of rotation of the abutment and the adaptorrelative to each other. The co-operable indicia can also include primaryand secondary indicia such that the primary indicium of the adaptor isrotatable in relation to the primary or secondary indicium of thecontour or multifunction abutment as it is rotated to its desiredpredetermined position such that its primary indicium is ideallysituated. In this way, the primary indicium of the abutment candetermine the position of the contour or multifunction abutmentpost/adaptor assembly as it is rotated into its preferred position.

The primary indicium of the adaptor can be an engaging polyhedralfixture. In such embodiments, the engaging polyhedral fixture provides apositive seat when engaging the primary or secondary indicia of theabutment possessing a mating reciprocal polyhedral fixture.

The Multifunction Abutment can also have a polyhedron on its top surfacethat is shaped to receive another polyhedron with a matching engagingconfiguration that is inserted over it, engages it, and is, in turn,connected to the prosthetic device via a chemically cured, light cured,or other combination method to create the screw retained prosthesis.

In certain embodiments, that polyhedron on the abutment can be a conewhose primary indicium is approximately 180° from the midpoint of thevertical angle correction point on the abutment and the engagingpolyhedron is a cylinder. The cone can also have a flat at its primaryindicium which provides a positive seat at its primary indicium of theconnecting cylinder during the assembly phase, which also preventsnatural rotational forces associated with a cylinder on a cone fromdislodging it.

III. The Universal Contour Abutment System (FIGS. 1-26C)

The Universal Contour Abutment can be one of a plurality of devicesincluding but not limited to temporary abutment posts, final preformedabutment posts, cast abutment posts, pressed abutment posts, or milledabutment posts, or other posts fabricated by another suitable means thatreceive implant crowns, set of crowns, bridges, and other prostheses forrestoring dental implants that can either be cemented or screw retained.

Specifically, in certain embodiments, the base of the abutment has apreformed symmetrical configuration such as a cylinder, conical shapedcylinder, or other appropriate configuration to support the gingiva.Once the abutment has been rotated to ideally situate it, its base canalso have a preformed asymmetrical configuration to support the gingivawith an emergence profile that is similar to a natural tooth that wouldbe in that implant fixture's position. Additionally, interim abutmentsor healing caps, and impression, scanning, or imaging posts or othertissue engineering prosthetic devices can share the same preformedsymmetrical or asymmetrical configuration as the base of the abutment todevelop a custom emergence profile.

In certain embodiments, the abutment has standardized preformed anteriorand posterior tooth abutment preparations over custom contour gingivalbases. Ideally, the abutment can also have preformed tooth abutmentpreparations of maxillary or mandibular incisors, canines, premolars, ormolars over custom contour gingival bases.

The Preformed Standard Abutment (Unprepped) Features:

Further provided is an assembly for initiating tissue trainingcomprising, in combination, a polyhedron device to be received in adental implant and a guided tissue punch having an internalconfiguration to match to the configuration of the polyhedron devicewith a preferred diameter for the tissue opening over an implant,wherein the tissue punch is rotated over the polyhedron which centersthe tissue punch such that it creates the exact opening over the implantas it is rotated over the polyhedron until it excises the tissue alongthe central axis of the implant, regardless of its vertical angulation(FIGS. 7 and 8 ). The polyhedron can be a surgical guiding screw with along cylindrical shank, which is first threaded in the dental implantand is followed by the rotation of the guided tissue punch having aninternal configuration to match to the shank of the screw until itexcises the tissue over the implant.

In an alternate aspect of the invention, a hand piece drill including adrill bit can also be used to excise the tissue along the central axisof the implant. The drill bit can be rotated over the guiding screw orother polyhedron which centers the drill bit such that it creates theexact opening over the implant as it is rotated over the polyhedron.

Use of the Preformed, Unprepared Abutment:

Also provided is an automated, simplified crown and bridge implantrestoration, wherein an adaptor to be received and seated on a dentalimplant in a predetermined position relative to the implant, which, inturn, receives a preformed, unprepared abutment having an asymmetricconfiguration upon which an interim coping and a referencing coping areindividually seated, all of which have cooperable indicia for aligning,synchronizing, and referencing the interim abutment to create the finalabutment, comprising the steps of rotating the adaptor and abutmentrelative to each other such that the abutment is in a predetermined,preferred position that is then noted, aligning and seating an interimpreformed coping composed of acrylic or another suitable temporaryrestorative material for molding a temporary crown to it such that it isautomatically in the preferred position, removing the interimcoping/temporary crown assembly, seating a referencing coping with thesame alignment as the interim coping to identify and register theposition of the adaptor and the abutment, and fabricating a final crownto seat on the abutment or another final abutment having the samepreferred horizontal and vertical position as the interim abutment.

The co-operable indicia can include graduations for indicating thedegree of rotation of the abutment and adaptor relative to each other.The co-operable indicia can include primary and secondary indicia suchthat the primary indicium of the adaptor is rotatable in relation to theprimary or secondary indicium of the abutment as it is rotated to itsdesired predetermined position.

The acrylic coping can be seated on the abutment such that its primaryindicium is aligned with the primary indicium of the abutment prior torelining a previously fabricated or molded temporary crown. Thereferencing coping can be seated on the abutment to identify andreference its primary indicium that is aligned with the primary indiciumof the abutment along with registering the primary and secondaryrotation points of the abutment in relation to the primary indicium ofthe adaptor that were previously noted.

The referencing coping can be an impression coping that is removedwithin the impression and serves as a referencing and seating device foran abutment replica with the same geometry as the interim abutment withthe model being poured and the final abutment being cast, pressed, ormilled or fabricated by some other type of method such that it has thesame relationship to the implant's index as the interim abutment orhealing cap, which is followed by the fabrication of the overlyingprosthesis.

In certain embodiments, the prosthesis is fabricated, and then seated onthe interim abutment after the removal of the temporary crown orprosthesis, which, as a result, becomes the final abutment.

In certain embodiments, the referencing coping is a scanning coping witha geometric configuration that is ideal for an intraoral or bench scanto register the position and configuration of the interim abutment tocreate a milled abutment. The referencing coping can also be an imagingcoping with a geometric configuration that is ideal for a CBCT scan toregister the position and configuration of the interim abutment which isthe matrix for creating the milled crown and/or abutment. In a preferredembodiment, the abutment's primary indicium itself is easilyidentifiable by a scanner.

The preformed abutment can have either a symmetric or asymmetric basewith a preferred geometry of appropriate configuration and depth tovertically position the base in relation to the gingival architecture,because it is always in a preferred position.

The Universal Healing Cap and Interim Abutment with Preformed GingivalArchitecture

The Universal System provides preformed custom gingival contours,regardless of the degree of asymmetry of its healing caps ormisalignment of implant index. An adaptor to be received and seated on adental implant is rotated about in a predetermined position relative tothe implant. The adaptor and the healing cap have co-operable indicia todirect the rotation of the healing cap to a generally desired horizontalpredetermined position, when the adaptor is seated on the implant withthe healing cap's primary indicium situated such that an abutment inthat position would have its primary indicium in that ideal position.

In one aspect of the invention, the healing cap having a symmetricconfiguration is a cylindrical healing cap. In a further aspect of theinvention, the healing cap having an asymmetric configuration is anon-cylindrical polyhedron. The asymmetric healing cap more naturallysimulates a natural tooth, and can, therefore, facilitate soft tissuehealing better than the symmetric healing cap.

The adaptor can also be first rotated over the implant to apredetermined position with the healing cap then being inserted over theadaptor in its preferred position. With either rotation, the co-operableindicia can include graduations for indicating the degree of rotation ofthe healing cap and the adaptor relative to each other. The co-operableindicia can include primary and secondary indicia such that the primaryindicium of the adaptor is rotatable in relation to the primary orsecondary indicium of the healing cap as it is rotated to its desiredpredetermined position.

The Indexed Healing Cap

Certain embodiments provide a method of restoring dental implants byusing indexed healing caps or similar tissue supporting interim devicesthat are also referencing devices which have co-operable indicia foridentifying and referencing adaptor and abutment positions withouthaving to be removed from the implant. This thereby simplifies thefabrication of abutments and/or prosthetic devices for restoring dentalimplants. In certain embodiments, rotating the healing caps over theiradaptors and the adaptor/healing cap assemblies over their implantsaccording to an automated and interactive clinical and/or digitalprotocol are performed such that they are situated in preferred verticaland horizontal predetermined positions over their implants. Thereferencing posts such as impression posts, or the scanning posts can beinserted over an index on each healing cap such that the primaryindicium of the referencing post is aligned in relation to the primaryindicium on the healing cap's index with an impression, intraoral orbench scan, or a CBCT scan being taken of the healing cap/referencingpost assembly such that it registers the adaptor's position in relationto the implant index, the indexed healing cap position in relation tothe adaptor, the referencing post in relation to the indexed healing capalong with the other anatomic structures in the jaw. A cast, milled, orother abutments to those preferred positions, can be fabricated byfollowing the implant prostheses.

The co-operable indicia can include graduated reference points and/or amechanism of primary and secondary indicia such that the primaryindicium of the adaptor is rotatable in relation to the primary andsecondary indicia of the indexed healing cap as defined by the desiredpredetermined position of the healing cap.

The automated and interactive clinical and/or digital protocol includeschoosing the appropriate indexed healing cap or similar prostheticcomponent having the desired geometric shape for the tissue over theimplant, rotating it as necessary in either a predetermined clockwise orcounterclockwise direction such that the primary indicium of the adaptoris positioned at a particular primary or secondary indicium point of thehealing cap and is set in relation to the index of the implant such thatits gingival contours are ideally situated in a preferred, predeterminedposition over the implant.

In certain embodiments, the primary indicium of the healing cap islocated at the center point of the healing cap as it bisects the ridgeat a 90° angle in the sagittal plane or another preferred position,which, therein, identifies the location for seating the impression orscanning post.

In certain embodiments, the primary indicium of the impression post, orscanning post overlay the primary indicium of the healing cap. The indexof the healing cap can have a polyhedron adjacent to the primaryindicium of the healing cap such that the polygon of the polyhedron isbisected at that point. The primary indicium on the polygon of thehealing cap receives the impression or scanning post such that theprimary indicia overlay each other and, thereby, capture the primaryindicium at its center point.

In certain embodiments, the polygon is an index that is an exact replicaof the abutment engaging index on the open end of the adaptor. Theadaptors and healing caps can be appropriately positioned on a modelfabricated from a fixture level impression with implant analogs in orderto seat scanning posts for a bench scan.

The multiple indexed healing caps can be used in an impression, anintraoral scan, a bench scan, or a cone beam CT scan to create a set ofabutments, along with either a screw borne prosthesis or a crown'sbridge prosthesis over tooth abutment preparations. In certainembodiments, multiple indexed healing caps can be used to create a fullarch splint over crown and bridge abutments or over screw receivingabutments to receive a screw-retained prosthesis.

The primary indicia of the adaptor determines the seating of theimpression, scanning, or imaging post in relation to the healing cap'sposition via the primary indicia of the healing cap, therein,determining the preferred position of the final abutment whose primaryindicia is similarly situated.

The primary indicium of the adaptor can be an engaging polyhedralfixture to provide a positive seat when engaging the primary orsecondary indicia of the healing cap possessing a mating reciprocalpolyhedral fixture.

The assembly can include a single screw for securing the healing caponto the adaptor and the adaptor onto the implant in their predeterminedpositions.

The healing cap can be one of a plurality of symmetrical andasymmetrical devices of varying configurations that are seated onadaptors. The plurality of devices include gingivo-adaptors which arehealing caps and adaptors that are combined into one-piece assembliesfor connection to the implant (FIG. 8G), wherein the open end of thedevices have the preferred configuration and/or index of the chosenadaptors and the free end has the configuration and/or index of theparticular implants.

The healing cap can be composed from a plurality of materials includingtitanium, titanium alloy, zirconia, porcelain, or other suitablematerials and can be coated by anodizing or some other method. Theprimary indicia of the healing cap can determine the position of theabutment post when it is to be rotated such that its primary indiciumand that of the abutment are in the same preferred position.

The impression posts, scanning or imaging posts or other prostheticdevices can have preformed symmetrical configuration that match theconfiguration of the healing cap's base.

The healing cap can have an index on its open or top end with a primaryindicium for situating a registering device such as an impression postor a scanning or imaging post for impression taking or intraoral orbench scanning or CBCT scan imaging after the healing cap has beenrotated into a preferred position. The index is not limited to any onepolyhedron and can be protruding or recessed. The index can have thesame configuration as the underlying adaptor stud, and has the samegeometry and position of its polyhedrons.

FIGS. 27-31 show representative configurations of the universal contourhealing caps and abutment posts, which, in this embodiment, mimic theshape at the gingival margin of natural teeth from the gingivalattachment to the free gingival margin. These polyhedrons are examplesof a large array of possible gingival contour healing caps or abutments,and are, therefore, not limited to the configurations shown here. Forinstance, even though these healing caps show recessed prostheticcomponent engaging polyhedrons (405), the universal contour healing capscan come with an array of internal or external engaging polyhedrons orcan come without any prosthetic component engaging points. Although theprosthetic component engaging polyhedrons (405) (e.g., FIG. 28 ) aredepicted as being oval cylindrical recesses of equal dimensions, it isunderstood that the prosthetic component engaging polyhedron can be anypolyhedron shaped recess or protrusion, i.e., circular, rectangular,square, pentagonal, in any combination, etc. In at least certainembodiments, the prosthetic component engaging polyhedrons (405) arenon-uniformly positioned about the surface of the healing cap such thatthey can only be paired with their counterpart protrusion or recess in apredetermined configuration. Alternatively, the prosthetic componentengaging polyhedrons (405) are uniformly positioned about the surface ofthe healing cap, but at least one of the set of prosthetic componentengaging polyhedrons (405) has a different shape or size than the otherprosthetic component engaging polyhedrons (405) such that they can onlybe paired with their counterpart protrusion or recess in a predeterminedconfiguration.

FIG. 27 shows examples of maxillary teeth in the axial plane at theircervix: a representative central incisor (441), lateral incisor (442),canine (443), premolar (444), and molar (445), and FIG. 28 showsexamples of mandibular teeth in the axial plane at their cervix: arepresentative central incisor (446), canine (447), first premolar(448), second premolar (449), and molar (450). The examples shown haveprimary reference indicia (421) and secondary reference indicia (422,423, 424) that are located counter clockwise to the primary indicium andsecondary reference indicia (425, 426, 427) that are located clockwiseto the primary indicium, which in this embodiment are located at 45°,90°, and 135° away from the primary indicium (421). This invention isnot limited to these rotation points, which can be established in anymanner which would provide a preferred rotation.

In one aspect of the invention, a kit can contain a library of healingcaps including at least one of each of the maxillary central incisor(441), maxillary lateral incisor (442), maxillary canine (443),maxillary premolar (444), maxillary molar (445), mandibular centralincisor (446), mandibular canine (447), mandibular first premolar (448),mandibular second premolar (449), and mandibular molar (450).

Recessed engaging polyhedrons (405) for receiving impression posts orscanning posts (shown here) are located on the top surface of these andother healing caps and are described in detail in FIG. 28 , which alsoshows an external index in another embodiment. There are manypermutations and combinations of these healing caps, including thosethat have different reference indicia and engaging polyhedrons, andthose that may not have any recessed or external engaging polyhedrons orindexes, at all. Versions of these healing caps that are symmetrical(cylindrical, etc.) are shown in (FIGS. 30, 37, 38 and 47 ) with some orall of the reference markings and polyhedrons described above can alsobe used. Even though depicted as being symmetrical, their primaryindicia are set in relation to the primary indicium of the universalaligning adaptor for the purpose of situating, aligning, synchronizingand referencing all other components. For example they help set allimpression and scanning posts and abutments in relation to the implant'sindex. The universal contour healing caps and/or their facsimile can beused for surgical excision and gingival shaping (see FIGS. 47-48 below),for tissue training after implant exposure or during immediate load orimmediate tissue load procedures, as the base for temporary andpermanent abutments, and as a platform for receiving impression andscanning posts and other restorative devices.

FIGS. 29A-B illustrates a frontal and side view of an abutment with anasymmetric maxillary premolar tooth preparation (344) and preformed,scalloped gingival contours (340) with an extended depth (338). Theextended depth (338) of the abutment allows for the preformed, scallopedgingival contours (340) to be positioned above the gum line. The lengthof the extended depth (338) can be increased or decreased depending onthe health of a patient's gum tissue or other considerations by thesurgeon. While FIG. 30 illustrates an array of generic anterior andposterior abutments with symmetrical cylindrical collars: an anteriortooth preparation (332) making a 30° vertical angle correction (356), amedium sized posterior tooth abutments (333) making 0° (353), 15° (354)and 30° (356) vertical angle correction, and a larger posterior abutment(334) making a 0° (353) angle correction. There are a variety ofabutment shapes and gingival contours of changeable depths that can beused for the healing caps and abutments.

It is also possible to make horizontal angle corrections with thedevices and methods of the present invention. Therefore, for example,with 351 it is possible to achieve a 15° horizontal angle correction. Itis further contemplated that the devices and methods of the presentinvention can achieve 7.5° horizontal angle correction (by doubling thenumber of internal engaging flats of the abutment).

All of the abutments and healing caps in FIGS. 27-31 have the samehorizontal rotation capability as delineated above. Specificinteroperable devices and methods that the surgeon or restorativedentist uses when working with asymmetric and symmetric healing caps andabutments are shown in many figures throughout these drawings.

FIGS. 32-38, 39A, and 39B illustrate several configurations of universalhealing caps that can be used to establish tissue training. Many of theuniversal healing cap configurations can serve as platforms forimpression and scanning posts and abutments. Some of the universalhealing cap configurations can be asymmetrical, as shown in FIGS. 32-36and other ones can be symmetrical as shown in FIGS. 37 and 38 .Anatomically correct healing caps expand the capabilities of immediatetissue loading (no occlusal forces) and can train the tissue to apreformed, custom contour without any occlusal loading forces. Finalpreformed, cast and milled abutments can be made having matchinggingival contours, which provides greater precision with less work bythe technician or the restorative dentist. All of them are fabricated,rotated and seated on the implant in the same manner as shown for theabutments, in FIGS. 9A-25F with the adaptor or base unit and the healingcap either being rotated or counter rotated to reposition it to an idealsituation over the implant. Since the healing cap's primary indicium isset in relation to that of the adaptor such that it bisects the ridge inthe sagittal plane, it establishes the reference plane for seating finalabutments and all other cooperable components. This aligns impressionposts, scanning posts, and other such componentry in a set way inrelation to the universal aligning adaptor's primary indicia, and,therefore, to the implants' indexes, whether the impression is taken onthe healing cap or directly on the adaptor.

FIGS. 32-39B illustrate a variety of healing cap/adaptor combinationsthat are set in relation to the primary indicium of the adaptor. Theycome either with a smooth top surface such as the non-indexed asymmetrichealing cap that is shown in FIG. 32 , or the non-indexed cylindricalversion (not shown in these drawings), or have external or internalindexes or polyhedrons on their surface that allow the surgeon orrestorative dentist to insert impression posts or scanning postsdirectly on them, after they have been rotated, thereby capturing theexact position, vertical angulation, tissue contour and depth, and otherpertinent information without having to remove them. This dramaticallysimplifies implant restoration technique. The registration techniques(impression or scan) are shown in detail in FIGS. 70-92 .

FIG. 32 shows an asymmetric healing cap (400) having primary indicia(421 and 411) that have been placed in a predetermined position on thehealing cap, which, in this embodiment, is configured to be seated onthe adaptor (100) such that the primary indicia of the healing cap (411,421) and those of the adaptor (120, 121) overly each other, whichsignifies that no rotation is to be performed (0° rotation) in relationto its primary indicia (120 and 121). Once the assembly is inserted onthe implant, a single fixation screw (200) secures the healing cap tothe adaptor and their assembly to the implant.

FIGS. 33-39B also demonstrate the relationship of their individualhealing caps to their adaptors without any horizontal angle correction.FIGS. 33 and 34 show the asymmetric indexed healing cap (401), with anexternal index (406) configured to receive a universal impression postor scanning post in order to take a direct impression or take a scanwithout having to remove the healing cap. FIG. 33 shows an embodiment ofthe indexed asymmetrical healing cap (401) having an external index(406) or an internal index (not shown) such that one of its flats isbisected by a line drawn from the primary indicia of the healing cap(411, 421) and has a primary indicium (418) that is aligned with them atthat point. This determines the seating of all components on the healingcap that has been positioned in a set way in relation to the adaptor andto the underlying implant. In this example, the index is an octagon thatmimics and overlays the octagon stud of the adaptor upon which it isseated with its primary indicia (120, 121) directly below. But, onceagain, the index can be any external or internal polyhedron that servesas a reference guiding plane for a paired polyhedron index on theimpression post, scanning post or any other component seated on it inrelation to the adaptor stud. This index can be a match to theunderlying adaptor's or implant's index (e.g., octagon healing cap index(406) to an adaptor's octagon index) such that their flats are alignedin relationship to each other, or can also have some other index that isset in relation to the underlying index of an adaptor or implant.Certain embodiments have an external or internal index surrounding thescrew access hole with the same number of flats as the adaptor uponwhich the impression posts or scanning posts are seated such that theirprimary indicia overlay those of the healing cap, which thereinregisters the exact position of the adaptor's index and primary indiciumin relation to the healing cap's primary indicia.

FIG. 34 shows the indexed healing cap (401) being seated on a genericadaptor (100), which does not have any primary and secondary indicia,but utilizes the same situating techniques outlined above. In thisillustration, the primary indicia of the healing cap (411, 421), alongwith the first rotation stop (415 on the collar, 425 on the top), whichhere represents a 15° horizontal rotation and the second rotation stop(426) for a 30° horizontal rotation are shown. These rotation points(425, 426) are some of the secondary indicia located in the clockwiserotation sequence.

These primary and secondary indicia of the healing cap and theirrelationship to the primary indicium of the adaptor help define thepredetermined increments of rotation for repositioning, aligning,synchronizing, and referencing all other co-operable abutments and otherprosthetic components according to an automated and/or integratedclinical and/or digital protocol. Once again, the prosthetic components,therein, are decoupled from dependence upon the coarse rotations aroundthe implant's index, which is substituted by the much more refinedincrements of rotation of the adaptor system, such that the surgeon orrestorative dentist can precisely position the healing caps or abutmentsand, therein, establish the most natural gingival contours of thegingiva over each implant. It is important to note that the techniquesfor ideally situating the gingival contours of the healing caps areapplicable to the universal contour abutments, as well. Furthermore, itis understood that the surgeon or restorative dentist may elect to usean interim abutment having the same gingival architecture instead of thematching healing cap.

FIG. 35 illustrates the use of the universal asymmetric indexed healingcap (401) that directly connects to the implant having a base unit withan external index (406), in this case an octagon, on the top thatreceives the impression post or scanning post, and has a hexagonprotrusion at the base for insertion into a hexagon implant, in thisexample. This embodiment will fit into any implant having any index, butthe adaptor and the abutment or healing cap must first be rotated orcounter rotated to position it such that the overlaying abutment will beideally situated over the implant. It is understood that, as usedherein, the concept of rotation and counter-rotation involves theseparation of the adaptor from the abutment or healing cap, as the casemay be, and then rotating or counter-rotating it to reposition theindicia relative to each other. The technique is detailed in thedescription of FIG. 38 , below. In this case, the direct connect indexedhealing cap (or referencing abutment) can also be used, at the time ofimplant insertion, to serve as a guide for situating the fixture when itis being secured to the bone by centering the primary indicium of thehealing cap in the sagittal plane as it bisects the jaw at that point.The examples shown above are for demonstration purposes only, and arenot limited to the use of any specific polyhedrons being used to centerthe healing caps and receive the impression posts and scanning posts.The universal indexed healing cap can have several versions of externalor internal polyhedrons, including ones that have been separatelypositioned in relation to the healing cap's indicia or those that areindexes over the screw access hole and are set in relation either to thehealing cap's primary indicium or to the underlying adaptor's primaryindicium where applicable.

As an example, FIG. 36 shows another asymmetric healing cap (408) whichcan receive the impression post or scanning post in recessed polyhedrons(405) of any type. Of course external polyhedrons of a similar positionand shape can also accomplish the indexing of the impression or scanningpost. Shown in this example are the primary indicia (411, 421) and thesecondary indicia (425, 426). Also shown are standard gingival contours(430). It is understood however that gingival contours can be providedas preformed custom bases depending on the intended location of thehealing cap. Therefore, it is contemplated that healing caps could bemade with gingival contours configured for the mandibular, maxillary,posterior or anterior positions or orientations.

FIG. 37 provides a universal cylindrical (symmetric) indexed healing cap(403) that is optimally situated with the techniques outlined above inthe description of FIG. 33 in order to establish the ideal situation ofthe primary indicium of the healing cap (421) and its index (411). Theseprimary indicia serve as the reference points for seating the impressionposts, scanning posts, and abutments seated, even though the rotation ofthe healing cap does affect any change in gingival contours. Thishealing cap has a cylindrical collar (437). The impression or scan isachieved without the restorative dentist having to remove the healingcap. FIG. 38 discloses a direct connect, one piece, cylindrical healingcap (404) that, when rotated with an interfacing abutment, will find theideal position for restoring the implant with any angle correctingabutment such that the misalignment of the implant's index has beeneliminated.

FIG. 38 illustrates, as another embodiment, an example of the directconnect, universal aligning symmetrical healing cap (404) that can beconnected to any implant, rotated in set, horizontal increments untilits external index is situated such that an abutment can be placed in apreferred position over the implant, regardless of the misalignment ofthe implant's index. In this example, a hexagon implant is receiving thehealing cap (404) which has an external octagon stud. This embodiment isdemonstrating that, even though the octagon stud on top of thecylindrical healing cap and the hexagon projection that is inserted inthe implant are one piece, it can be finely rotated about the verticalaxis, achieving an optimal positioning within a maximal 7.5° deviationfrom the ideal direction until the healing cap is positioned until anoverlaying abutment is ideally situated. When the primary indicia of thehealing cap (421, 411) are in a sagittal plane that bisects one of thehexagon flats of the projection that is inserted into the implant, theabutment can be seated on the index and simultaneously rotated over thehealing cap to assist in locating the center point. Unlike the previousexamples, the primary indicia of the healing cap (421, 411) are notoptimally situated, but rather are rotated until the overlying abutmentis ideally placed within 7.5° of the ideal configuration. In theseexamples, the impression and scan posts are seated such that theirprimary indicia are aligned with the primary indicium of the healing cap(411), which registers the primary indicium of the adaptor, as well.This embodiment is not limited to this healing cap with an octagon indexstud and a hexagon implant projection, but, rather, can be used in anynumber of combinations of dissimilar indexes.

FIG. 39A and FIG. 39B illustrate the low profile, scalloped healing capwith sides that are higher than the recessed center, which keeps themargins of the gingiva from growing over the healing cap, whileproviding enough room to receive an overlaying interim replacementtooth. FIG. 39A shows a scalloped healing cap (407) that maintains theopening over the implant having been seated on an adaptor (120). FIG.39B shows the indexed version of the scalloped healing cap (409), whichis seated on an adaptor and has an external index (406) having a primaryindicium (428) that, without any rotation, overlays the primary indiciumof the adaptor (120) and receives an impression or scan post forregistration. An internal index on top of the healing cap can also beused to receive the impression or scan post.

Tissue Engineering

The Contour Abutment System applies a systematized tissue engineeringprotocol wherein abutments are created to match to gingival contoursthat are established when the implants are ready for tissue loading orocclusal loading. Rather than adjusting the gingival contours of thefinal abutments to match to the gingiva, the gingiva is sculpted toblend with the preformed gingival contours of the healing caps orinterim abutments. Due to the unique rotations of the contour abutmentsystem components in 15° or less increments along with theirsynchronization to the Universal Aligning Adaptor, even asymmetricalgingival contours can be created, registered, and translated in exactform to the gingival architecture of the final abutments.

Tissue engineering can begin with the use of a guided tissue punchhaving an internal configuration to match to the configuration of apolyhedron device that is first inserted in an implant, followed by thetissue punch being rotated over the polyhedron. This centers the tissuepunch, regardless of its vertical angulation, such that it creates anexact opening over the implant as it is rotated over the polyhedronuntil it excises the tissue along its central axis of the implant. Thepolyhedron can be a surgical guiding screw with a long cylindricalshank, which is first threaded in the dental implant and is followed bythe rotation of the guided tissue punch having an internal configurationto match to the shank of the screw until it excises the tissue over theimplant. The Guided Tissue Punch excision is an optional procedure priorto creating the custom gingival contour, below.

Custom tissue engineering at the time of implant loading is provided byan adaptor and a set of tissue engineering components having co-operableindicia, including a healing cap, interim abutment or other prostheticcomponent whose preferred, preformed gingival contours serve as atemplate to develop the gingival architecture over an implant, areferencing device such as an impression, scan, or imaging post, whosebase is a replica of the interim component such that it has the samegingival contours, and a final abutment whose base is also a replica ofthe interim component. In this embodiment, the tissue over the implantis initially opened. Then an adaptor and a chosen interim component isrotated relative to each other and their assembly relative to theimplant via their co-operable indicia such that the desired gingivalcontours of the interim abutment are ideally situated over the implantto most naturally support the tissue with the proper emergence profile.The gingival tissue is sculpted as the adaptor/interim prostheticcomponent assembly is seated on the adaptor so that the tissue conformsto the architecture of the interim component. The interim component isremoved from the adaptor and the appropriate referencing device isseated with the same relationship to the primary indicium of theadaptor. In this manner, it is possible to identify and register thecomponent's gingival contours when they are ideally positioned.

The preformed abutment can have a symmetric or asymmetric base with apreferred geometry of appropriate configuration and depth to verticallyposition the base in relation to the gingival architecture.

Once ideally positioned, the final abutment can be fabricated such thatits base mimics the subgingival contours of the interim abutment, andremoving the adaptor and the interim abutment and replacing it with afinal abutment which also has co-operable indicia for preciselypositioning its gingival contours with its gingival architecture havingthe identical gingival architecture over the implant

FIGS. 40-46B disclose, in detail, devices and methods to control theinsertion of the implant and the manipulation of the tissue above thesite as described above. To begin with, FIGS. 40-46B show the use ofanatomic universal paralleling posts during implant site preparation forthe surgeon to visualize the adaptor/abutment assembly as the surgeon orrestorative dentist will see it. FIG. 42 shows a universal anatomicparalleling tool, which provides the surgeon with the ability to seewhat the restorative dentist will have as a fully contoured abutment onan adaptor, as dictated by the osteotomy being drilled. In FIG. 40 thesurgeon is drilling the first pilot hole, and in FIG. 41 the angulationof the projected implant as dictated by the underlying bone isillustrated, and in FIG. 42 it is shown that a 30° angle correctingparalleling post (810) with an anterior tooth abutment design (812) hasbeen chosen to fit via a stem (811) with the same diameter as the sizingdrill such that it fits into the osteotomy site. FIG. 44 shows theparalleling post (810) being seated in the osteotomy site. FIG. 43 showsthat the paralleling post (810) with the abutment (812) near the crestof the bone can be used to assess angulation, position and parallelismusing a replica of the future abutment.

FIGS. 45A-46B show the use of universal guided tissue punches forcreating a precisely positioned, minimally invasive tissue opening whencreating the osteotomy for implant insertion, or exposing the implantfor restoration. FIG. 45A shows the use of the universal guided tissuepunch to create a precise excision of the gingival tissue overlying theosteotome site using a guiding tool, and is particularly useful duringthe “flapless” surgical technique or when immediately loading a healingcap or abutment. After an initial tissue opening is created at theprojected implant site, initial drills of appropriate diameter are usedto drill the initial osteotomy and the guiding cylinder is inserted. InFIG. 45B an initial preparation of the osteotomy has been done and aguiding cylinder (805) has been inserted in the site. A guided tissuepunch (804) is rotated over the guiding cylinder (805) in FIG. 45B untilit is seated as shown in FIG. 45C. The universal guided tissue punch(800) shown in FIGS. 46A-B provides an exact tissue opening over apreviously inserted implant with a significant savings in implantexposure time, as well as providing tissue preservation as a precise cutis created over the implant head. The cutting edge (802) of the tissuepunch has an outer diameter of about the same outer diameter as the topof the implant. A surgical guiding screw (801) with an extra-long shankis threaded into the implant's internal thread, once its cover screw hasbeen located and removed. The guided tissue punch (800) is then insertedover the guiding screw such that its internal polyhedron (803) engagesthe shank of the punch, which is then rotated until the tissue isremoved over the implant. This preferred embodiment is not limited tothe use of a guiding screw, when, in fact, any polyhedron that isinserted in the implant, such as an adaptor, can also provide thereference plane for rotating the universal guided tissue punch as itcuts the tissue.

In another embodiment, one can expose the cover screw to locate itsindex. A guided tissue punch (804) with a polyhedron configured to matewith the polyhedron of the cover screw can be inserted such that it isseated. The cutting edge (802) of the tissue punch has an outer diameterof about the same outer diameter as the top of the implant. The guidedtissue punch can then be rotated until the tissue is removed over theimplant.

To summarize, the Universal System provides automated tissue engineeringfrom implant exposure to creation of the final abutment and itsinsertion. First, a precise cut over the implant establishes the initialopening, as described above. Then a preformed universal contour healingcap or interim abutment (FIGS. 47, 48 ) is used as a surgical templateto scallop the gingival tissue over the implant to a predeterminedcontour, which is followed by using an impression or a scan registrationdevice having the identical gingival architecture (FIGS. 76, 77, 81 and86, 88-92 ). The final abutment or other prosthetic component is eitherfabricated utilizing this preformed gingival architecture or another onethat can be modified, but effectively blends with the newly sculpted“sulcus”. To start the process, either a symmetrical, cylindricalhealing cap ((402), FIG. 47 ) or an asymmetrical custom contour healingcap (401, FIG. 48 ) is first repositioned by rotating the primaryindicium of the adaptor to one of the primary (411) or secondary (425 or426) indicium positions of the healing cap such that the primaryindicium of the healing cap (411) is ultimately situated within 7.5° ofthe ideal position over the implant, when rotating in 15° increments (aspreviously shown in FIGS. 1-39B). As the adaptor/healing cap assembly isseated, the tissue is sculpted to blend with its subgingival contours(in this case, to the shape in the cross section plane at the gingivalmargin of a maxillary central incisor). A matching universal contourabutment can also be used as a surgical template via the steps outlinedabove for the healing cap. When the tissue is ready, the appropriateuniversal impression post (600) or scanning post (700) having thematching base is selected to register that gingival contour as well asother pertinent configurations for physical abutments and devices ortranslates the configuration data for virtual abutments and devices to asoftware program (see FIGS. 70-92 ). Final abutments are chosen with theidentical gingival architecture, which completes the fully automatedprocess of establishing ideal subgingival anatomy around an abutmentthat is ideally situated on an implant. It at least certain embodiments,as illustrated in FIGS. 47 and 48 , the healing cap has recessedengaging polyhedrons (405) to facilitate the attachment of the abutment,post, or other devices to be attached to the healing cap.

IV. The Universal Multifunction Abutment System (See FIGS. 49-69C)

FIGS. 49-69C illustrate the use of the universal multifunction abutmentto retain a screw borne prosthesis such as a hybrid screw down denture,an over denture, a screw down crown, set of crowns or bridge, or anyother type of screw borne prosthesis. The post head (300) shown in FIGS.1-3 and the multifunction (500) shown in FIG. 49 are two differentabutment versions of the universal system that fit on the same universalaligning adaptor (100). Therefore, the configurations and descriptionsof the adaptor (100) and fixation screw (200) used to secure the posthead (300) to the implant shown in FIGS. 1-3 are exactly the same forthe multifunction abutment (500) shown in FIGS. 49 and 50 . The primaryand secondary indicia (321 and 325) for the post head in FIG. 1 are thesame for the multifunction abutment, but have different part numbers toshow that they are primary and secondary indicia on the multifunctionabutment, instead (521, 522, FIG. 54A and 526 FIG. 54B,C). The bottomend at the abutment's base (369, FIG. 1 ) of the post head is the samefor the multifunction abutment (not shown), since they both fit on thesame adaptor collar (130, FIGS. 1 and 54C). FIG. 49 illustrates an anglecorrecting universal multifunction abutment (500) seated on a universalaligning adaptor (100) that is seated on an implant (10) with atrichannel index (21). The fixation screw (200) is inserted into thescrew access channel (565) and secures the universal aligning adaptor(100)/universal multifunction abutment (500) assembly to the implant.This particular multifunction abutment is making a 30° vertical anglecorrection (556). In this embodiment, the universal multifunctionabutment has a cone projection (572), which receives a prosthesisconnecting polyhedron, in this example a cylinder (580) in a specificmanner over its primary indicium (see FIG. 54A, 520 ), which is, inturn, affixed to the abutment with a fixation screw (575) as it isinserted into the guiding/retaining threads inside the cone (574). Thecylinder has scribe lines in mm increments (581) for sizing it and forretention inside of a prosthesis restorative material, and is described,in detail, below. FIG. 50 shows the cylinder (580) seated on the coneprojection of the abutment (572), which is then secured to the abutmentwith the fixation screw (575), which engages threads within the cone(574).

It is also possible to design a particular multifunction abutment makinga 0° vertical angle correction (553).

FIG. 51 shows the cylinder seated and affixed to the multifunctionabutment. In this embodiment, the cylinder (580) has a flat surface(581) that is set in relation to the flat of the cone (573), which is,in turn, in a set relationship to the primary indicium of the universalaligning adaptor (not shown). FIG. 54A shows a multifunction abutmentthat has not been rotated, as indicated by its primary indicium (521)being in line with the primary indicium of the cone's flat (FIG. 54A,520 ) and the primary indicium of the adaptor (121). This flat or otherpolyhedron can be in any number of positions and provides a positiveseat for consistent seating of the cylinder. This flat (573) to flatmating surface (587) provides an antirotation of the cylinder, which, inturn, resists breakage of the bond between the cylinder and theprosthesis, when the prosthesis is under occlusal load from function,especially when a cantilever tooth or set of teeth are a part of theoverlying prosthesis. In at least certain embodiments, the flat of thecone (573) along with the primary indicium are located at a center linethat is 180° from the midpoint of the angle correcting polygon. Inanother embodiment, the cone of the universal multifunction abutmentdoes not have a flat, but rather has a primary indicium at its centerline. A cylinder that does not engage any flat on the cone can also beused with the multifunction abutment. The cylinder (580), in thisembodiment, has an internal thread (574) at its base to receive thefixation screw (575) prior to seating the cylinder which prevents screwdroppage, and also has an internal thread (584) at its top to receive asealing screw (585) after the cylinder has been sized. This sealingscrew allows quick access to the fixation screw of the cylinder when theappliance is to be removed, thereby eliminating the need for therestorative dentist to drill out a composite or acrylic plug duringhygiene or other appliance removal appointments. The external surface ofthe cylinder has external configurations for retention (589) which, inthis embodiment, are actually measurement score lines (582) that serveas cut lines for the surgeon or restorative dentist or dental technicianto size the cylinder such that it does not protrude beyond theprosthesis. In addition, in another embodiment, the bonding sleeve hasan external configuration to receive a connecting ring and bar (notshown).

Although FIGS. 49-55 show one embodiment of the abutment and connectingdevices, there is a wide array of possible configurations of theuniversal multifunction abutment's shape, projections, polyhedrons andtheir relationship to the universal aligning adaptor which, in general,is configured such that the abutment's cone and the mating cylinder arealigned according to the primary reference indicium of the multifunctionabutment, which, therein aligns them with other prosthetic components inthe system, including those registration devices that are seated on thecones. Although the preferred internal configuration of the cylindershown here is a cone or similar polyhedron to guide and secure thefixation screw, it can have any other matching configuration to matewith a cone or other polyhedron projection on the abutment, or have nointernal configuration at all.

FIG. 52 illustrates another method of bonding the implant supportedprosthesis to the cylinder using an interfacing bonding sleeve (586),which is made of a suitable material according to the composition of theappliance and provides a stronger connection to the appliance, since itis first fused directly to the cylinder with an appropriate adhesive orcement. The bonding sleeve can also serve as a vertical stop duringprocedures for converting the denture to a transitional hybrid, whichcan save significant “chair time”. The cylinder (580) can also haveinternal threads (583) to secure the cylinder fixation screw. Thecylinder (580) can also have internal threads (584) to secure thesealing screw (585). Although exemplified as a threaded sealing screwand matching internal threads, in at least certain embodiments, thesealing screw could be a pressable cap that does not require a threadingaction to secure the sealing screw to the cylinder. In such anembodiment, friction or an outwardly expanding radial force seals thecylinder with the sealing screw.

FIG. 53 shows that the 0° abutment has been seated such that the primaryindicia of the adaptor and the abutment are aligned without any rotationhaving been performed. The 0° abutment can still be rotated to any oneof the secondary indicia to ideally situate the tooth preparation and/orthe gingival architecture. Once aligned, the assembly is secured with afixation screw (575) that secures the cylinder to the abutment as itengages internal threads of the abutment fixation screw (250).

FIG. 54B illustrates a 30°, angle correcting universal multifunctionabutment that is being rotated to an ideal position and then beingseated on an implant which has been inserted into the jaw with a 30°horizontal misalignment. Once appropriately seated, the cylinder isconnected to the abutment such that the prosthetic device (in this casea single crown) is secured to the abutment with the fixation screw(575). While this technique is the same for all screw bearing abutmentsand screw borne prostheses (according the techniques outlined in FIGS.1-39B), it is particularly useful for creating a screw retained crown(shown here), set of crowns, bridge, or splinted “teeth” in an archwithout any flange or wide occlusal tables to compensate for the implantmisalignment. The components are decoupled from the coarse increments ofrotation provided by the implant's index, realigned by rotation of theprimary indicium of the adaptor to a predetermined primary or secondaryindicium of the abutment in finite increments of rotation. Themultifunction abutment (500) and the connecting cylinder (580) can bepreformed, cast, pressed, or milled, whichever is the preference of therestorative team. The Universal System provides the ability to fabricatea screw retained crown with either the multifunction abutment, presentedhere, or with the contour abutment described in FIGS. 1-39B.

FIG. 54A shows the primary indicia of the universal multifunctionabutment, one of which (520) is on a flat (573) of the cone (572), whichserves as a seating index of the overlying cylinder, and the other oneis directly below it on the collar of the abutment (521). In theembodiment shown in FIG. 54B, this abutment is being rotated counterclockwise to secondary indicium (b) (526), which results in a 30°rotation in this case, since the adaptor's index is an octagon and theimplant's index is a hexagon (see Table 4). In FIG. 54C, the rotatedabutment (500) is being connected with its secondary indicium (526) atposition (b) which is being lined up with the adaptor's primary indicia(120, 121) prior to rotating the assembly over the implant (10). Aprosthesis, which, in this case, is an anterior crown (544), is shown inFIG. 55 , as having the cylinder being cast, pressed or milled as a partof the coping, which, in turn, converts the coping to a screw downcrown. This method is particularly effective when restoring an anteriorimplant, wherein a screw down crown is preferred, but the screw accesshole would be unsightly. FIGS. 56A and B and 57A and B show twomisaligned multifunction abutments (551) being realigned (557) to anideal position, which situates and aligns their screw access holes forbetter esthetics and function.

Illustrated in FIGS. 58A-61 are the methods for realigning a misaligneduniversal multifunction abutment to reposition its screw access hole toapproximate the center of the occlusal table for a particularreplacement tooth seated over the implant. FIG. 58A shows an implantthat has been inserted such that its internal index, which in this caseis a hexagon, is not located in an ideal position for restoration, suchthat the adaptor's octagon center line (528, FIG. 58B) and the implant'shexagon center line (128, FIG. 58C) are aligned with each other and thecenter line of the abutment's 30° angle correcting axis (559), but theassembly is misaligned in relation to the implant's central axis in thesagittal plane as it bisects the ridge. This skews the abutment (557) inrelation to another one that has been aligned and optimally situated(558, FIG. 58A). In FIG. 58A the adaptor is being rotated counterclockwise to position (B) to achieve a 30° horizontal rotation and, inFIG. 59 , the adaptor and the abutment are being connected after therotation such that the adaptor's primary indicia (120, 121) are in theabutment's (“B”) position (523). FIG. 60B, (c) illustrate the assemblybeing rotated such that the center lines (559) of each abutment are inline with each other, but that the center lines of the adaptor's octagon(528) and the implant's hexagon (128) are no longer aligned. The endresult is that the misaligned abutment (557) is now in line and parallelwith the one next to it (558) by the rotation of the adaptor around theabutment and the assembly around the implant as shown in FIG. 61 . Notethe location of the primary indicium (128) in relation to the nearestvertex (line over the center of the vertex) in FIG. 58B vs. its locationafter the rotation as shown in FIG. 60C.

FIGS. 62-67 , illustrate problems associated with restoring misalignedimplants with crown and bridge abutments and FIGS. 68-69 show thechallenges of restoring an arch with screw retained abutments (in thisexample hexagon indexed), since angle correcting abutments that directlyengage the implant index are encumbered by its coarse increments ofrotation (60°). The effect of restoring misaligned, anterior angledimplants is also demonstrated in FIGS. 62-67 , and the compoundingeffects of restoring misaligned, angled implants around the curve of thearch is shown in FIGS. 68-69C.

FIG. 62 illustrates the use of a stent having ideal crown contours andpositions, which gives the technician a perspective on the requiredabutment corrections needed to achieve the preferred profiles andpositions. As an example, in FIG. 63 , implants 8 and 9 having beeninserted with misaligned indexes such that both of the angle correctingabutments, in this case, are angled distally as shown by the off-angleabutment center lines (557). FIG. 64 shows the rotation of the abutmentin implant #8 one hex stop or 60°, which results in the abutment centerline (557) still being misaligned, except that it is now angledmesially. In this example, when restoring a screw borne prosthesis, thescrew access hole ends up angled towards the mesial or distal line angleof the projected crown, which effects esthetics and/or function. Whenusing crown and bridge milled abutments, the milling program will haveto overcompensate for the mesial-distal misalignment by an extra millingof the mesial or distal side of the abutment in order for it to beparallel, which will give it a reduced emergence profile. However, asshown in FIG. 65 , this problem has been resolved by the dual rotationof the universal multifunction abutment or the universal contourabutment in combination with the universal aligning adaptor with a morerefined 30° horizontal rotation, which results in the center lines of 8and 9 (558, 559) now being situated in ideal positions. FIGS. 66-67 showa side view of the anterior angle correcting abutment at #8 or 9. In theleft hand drawing, it can be seen that the compounding problem thatresults when angle correcting abutments are also misaligned, whichresults in these 30° angle correcting abutments being unable to providethe full vertical angle corrections, since they are not optimallypositioned. In the right hand drawing, the improved angle correction inthe vertical plane as demonstrated by the axis line (559) can be seen,once the abutment has been realigned. Overall, realigning andreestablishing the restorative index to an ideal plane as the initialprocedure prior to fabricating a screw borne prosthesis or, in thiscase, a set of anterior milled abutments can make a dramatic differencein maintaining ideal screw access holes for the screw borne prosthesisor improved emergence profiles for the milled abutments. The techniquesof rotating the components according to the primary and secondaryindicia have been covered, in detail, in the previous drawings.

FIGS. 68-69C illustrate how the problem is further compounded comingaround the curve of the arch, which, once again, further complicates thegeometrical discrepancies, and, therein, decreases the likelihood that afull arch set of screw down crowns without denture flanges can befabricated, because the screw access holes will be off-angle and resultin bulky crowns. In addition, a full arch set of milled abutments willlose a significant portion of their emergence profile as the millingmachine parallels all of them. For the first time, a screw retained fullarch bridge or a full arch of anatomically correct milled abutments canbe consistently fabricated for any set of implants that are in almostany position. For example, in FIG. 68 , with implant #10 beingmisaligned distally and implant #12 being misaligned mesially, thecrowns will either be misshaped and bulky and have screw access holes(568) that are not in ideal positions (i.e., off angle), or the milledabutments may not be able to have adequate contours, once they aremilled for parallelism, because the abutment is seated on the hexagonindex, and, thereby, rotates in 60° increments, which means that amisaligned index causes its abutment to be off-angle to a maximal 30°deviation from the ideal direction to achieve optimal positioning. Thisdrawing show the results when the abutments are off angle at thatmaximal misalignment. FIGS. 69A-C show the rotation of the adaptor suchthat its primary indicium is repositioned prior to the combined assemblybeing horizontally rotated so that it rotates in 15° increments. FIG.69C illustrates how the resulting repositioning of the abutment and/orscrew access holes in 15° increments such that its abutment to beoff-angle to a maximal 7.5°, which precisely compensates for themisalignment and solves the problem. Therefore, as shown in FIG. 69C thepresent invention centers the screw access hole (569).

Certain embodiments provide an assembly for use in the process of dentalrestoration relevant to dental implant prosthetics comprising, incombination, an adaptor to be received and seated on a dental implant ina predetermined position relative to the implant and a multifunctionabutment seated on the adaptor's end. The adaptor's end is configured toreceive the multifunction abutment which is first rotatable about theadaptor followed by the adaptor/abutment assembly around the implantuntil the abutment's screw access hole is realigned to a generallydesired vertical and horizontal predetermined position to approximatethe center of the occlusal table of the tooth replica for thatparticular implant that has been fabricated on the screw borneprosthesis. The adaptor and the abutment have co-operable indicia foridentifying and registering the predetermined position of the abutment,wherein the co-operable indicia permits the adaptor and the abutment tobe rotated relative to each other into a predetermined position of theabutment while the adaptor is detached from the implant. The primaryindicia of the cone on the multifunction abutment can determine theseating of an impression post, a scanning post, or CBCT scan imagingpost, each of which can also have co-operable indicia such that theyreference the realignment of the abutment to its predetermined,preferred position that ideally situates the screw access hole whenfabricating the final abutment and/or the prosthesis that is seated onit.

The abutment can be one of a plurality of devices including but notlimited to preformed temporary abutment posts, preformed final abutmentposts, cast abutment posts, pressed abutment posts, or milled abutmentposts, or other fabricated posts wherein they receive the prosthesisthat is screw retained to them when restoring the implants.

The prosthesis can be one of a plurality of devices including but notlimited to an overdenture bar for receiving a snap on denture, a snap ondenture that is connected to retaining devices seated directly on theadaptors or implant abutments seated on adaptors without a connectingbar, a transitional hybrid prosthesis that has been converted from adenture to a fixed, screw retained prosthesis during the insertion of aset of implants in an immediate load procedure, a screw retained dentureor similar prosthesis with flanges, a screw retained crown, set ofcrowns or bridge with or without flanges.

The prosthesis can have a preformed, cast or milled framework or othersuitable framework incorporated within it, or can be seated on copingsor other interfacing prosthetic devices, that are, in turn, seated onimplant abutments.

The multifunction abutment and an adaptor can both be composed of thesame suitable restorative material.

In certain embodiments, the multifunction abutment and adaptor arerotated around each other followed by the rotation of their assemblyaround the implant such that the abutment is ideally situated. Theabutment is prepared, if desired, and the abutment and the adaptor arecombined by an appropriate method to create a single pieceabutment/adaptor assembly that is directly connected to the implantwithout a separate adaptor interface, which then receives the screwborne prosthesis.

In certain embodiments, a milled multifunction abutment comprised of anysuitable restorative material is fabricated by first rotating a virtualmultifunction abutment into a preferred position over a virtual adaptorusing the universal aligning system's automated and interactive clinicalprotocol in a milling software program to define the synchronized axisof rotation and, thereby, eliminate the mesial-distal misalignment priorto milling the abutment, followed by milling the abutment according tothe parameters established by the rotation such that either a singlepiece, final abutment for insertion on the implant which engages itsindex without an interfacing adaptor or a final abutment to bereceivable on the adaptor with the assembly then being inserted on theimplant is milled with the prosthetic device then being milled andaffixed to it.

In certain embodiments, the multifunction abutments are virtuallyrotated to the same positions as the ones that were registered during animpression or 3D imaging procedure, but the framework or overlyingcoping or set of copings is milled to fit on the previously seatedintraoral abutments. In certain embodiments, the framework is fabricatedafter the autorotation with the abutments being milled first followed bythe framework, or with the framework only being milled such that it willbe inserted over clinically placed abutments.

In certain embodiments, the abutments can be virtually auto rotated in asoftware program into their appropriate positions according to theautomated and/or interactive digital protocol scan code, which uses thelocation of each abutment's primary or secondary indicia in relation tothe adaptor's primary indicium along with a library of abutment digitaldata to mill the abutments to either be seated on the adaptors or to beseated directly on the implants.

In certain embodiments, the abutments can be virtually autorotated in asoftware program, after an intraoral, impression or scan, bench scan, ora CBCT scan that registers the alignment of the implant's index ineither the sagittal, coronal, or axial plane, wherein the automatedand/or interactive digital protocol is translated to the program.

In certain embodiments, the adaptor and the multifunction abutment havedissimilar polygonal structures and co-operable indicia such that therotation of the adaptor and the abutment results in increments ofhorizontal rotational adjustment over the implant to a predeterminedposition.

In certain embodiments, a healing cap can be removed from the cone onmultifunction abutment and an impression post or an intraoral or benchscanning post or a CBCT scan imaging post is seated over the cone suchthat its primary indicium is situated over the primary indicium of theabutment to register the abutment position, rotation, angle correction,gingival contours in relationship to the abutment, and the relationshipto adjacent anatomic structures.

In certain embodiments, the abutment can have a 0° score line oppositethe midpoint of the vertical angle correction to show the orientation ofthe multifunction abutment. The abutment can also have additional scorelines, for additional rotational stops to show the number of rotationstops to achieve the desired horizontal correction of abutmentangulation to quickly reproduce the rotation.

In certain embodiments, a bonding sleeve can be seated over a cylinderor other polyhedron for securing a hybrid screw down denture, a screwdown crown or fixed bridge, or other prosthetic device that is seated ona receiving polyhedron on the abutment, which has, in turn, been seatedeither directly on to an implant or indirectly on the implant via firstbeing seated on an interfacing adaptor chosen to be compatible to andreceivable on an associated implant and having a first portiondimensioned to extend above an associated implant, and the bondingsleeve can be connected to the overlying implant prosthesis. The bondingsleeve can be inserted over the cylinder or other polyhedron and bondedto it with an adhesive prior to or after seating the cylinder on to theabutment. The adhesive can be a biocompatible adhesive. The adhesive canbe a composite, dual cure composite, acrylic, or other suitable bondingmaterial.

The cylinder or other polyhedron can be seated on the abutment andappropriately torqued and the bonding sleeve can then be inserted overthe cylinder with an adhesive.

The bonding sleeve can be used as a vertical stop for taking the biteprior to or after connecting the bonding sleeve to the prosthesis.

In certain embodiments, a customizable reinforcing bar of a suitablematerial can be connected to multiple bonding sleeves to provideresistance to fracture of the screw borne prosthesis. A reinforcing ringwith a receptacle to receive the reinforcing bar which has been sized tofit between implants can also be seated on the bonding sleeve.

The Immediate Load Transitional Hybrid Prosthesis

Certain embodiments provide a method of immediately restoring dentalimplants at the time of their insertion with an immediate loadtransitional screw retained prosthesis by first using a set of aligningmultifunction abutments and universal adaptors having co-operableindicia wherein they are rotated and situated in finite increments suchthat the screw access holes of the abutments receiving the prosthesisare ideally located regardless of the type of implant indexes or theirmisalignment. In certain embodiments, the rotation of the adaptor andthe abutment having the co-operable indicia around each other areperformed. Following rotation of the adaptor and abutment, the assemblycan be rotated around the implant according to an automatic andinteractive clinical protocol with the abutment now being in a preferredvertical and horizontal predetermined position when it is seated on thepreviously inserted implant such that the screw access hole is as closeto the center of the occlusal table of the replacement tooth aspossible. The denture can be placed over the abutments and the holeswhere they seat over the abutments. A connecting cylinder can then beplaced over each abutment until it engages its receiving polyhedron. Theprosthesis can be affixed by connecting the cylinders to the denturetherein creating the transitional screw retained prosthesis.

The automated and interactive clinical and/or digital protocol caninclude choosing the appropriate multifunction vertical angle correctingabutment or equivalent prosthetic component having the desired geometricshape for that type of restoration over the implant, rotating it asnecessary in either a predetermined clockwise or counterclockwisedirection such that the primary indicium of the adaptor is positioned ata particular primary or secondary indicium point of the abutment and isset in relation to the index of the implant when the multifunctionabutment is being positioned in a preferred, predetermined horizontaland vertical location over the implant such that the screw access holeapproximates the center of the occlusal table of the replacement teeth.

The primary indicium of the multifunction abutment is ideally situatedin relation to the sagittal plane as it bisects the ridge when it is ata 90° angle to ridge and the abutment is in its ideal position.

In certain embodiments, a preop CT scan can be used to preplan theplacement of the implants and abutments prior to the surgery such thatthe primary indicia of the abutments are ideally situated. The implantcan be inserted in the bone according to its position in the CT scan.

The adaptor can be rotated around the abutment and the assembly can berotated over the implant such that the primary indicium of the adaptoris aligned with a specific primary or secondary indicium of the abutmentwhen it reestablishes the preplanned, preferred position of themultifunction abutment to compensate for implant index misalignment.

In certain embodiments, the restorative dentist seats the abutments andadaptors on the implants according to their position in the CT scangenerated model, reassesses their positions, and rotates them withrotatable, universal aligning analogs until they are ideally situated inthe CT scan generated model. Once ideally situated, the prostheticdevice can be seated over the abutments on the model and be prepared toreceive them. The restorative dentist then seats them on their implantsusing those rotation points as a guide.

In certain embodiments, cylinders that are antirotational having aninternal flat that matches to the configuration of the cone or otherprojection on the multifunction abutment are placed over the projectionsthat have a flat at their primary indicium to provide resistance todislodgement such that the primary indicium of the cylinder overlays theprimary indicium of the cone. This technique is not limited to cylinderswith an asymmetric internal configuration.

In certain embodiments, a bonding sleeve that adheres to acrylic orother restorative material can be used in the conversion of the dentureis seated over the cylinder with an adhesive and is connected to thedenture with an appropriate acrylic or composite to create a one-piecescrew retained transitional prosthesis.

In certain embodiments, a transitional appliance is replaced with afinal appliance by first removing the transitional appliance from themultifunction abutment and seating an impression post or scanning postover the abutment post such that their primary indicia are aligned, and,either an impression or an intraoral or a bench scan is taken toidentify and register the location of the abutment's primary indiciumand the adaptor's primary indicium in relation to the primary indiciumof the abutment and the implant's index, wherein either an analog isplaced in the impression such that its primary indicium is positioned atthe same reference points as established by the adaptor's primaryindicium, or the data is conveyed to the scan code of a milling softwareprogram with the virtual abutments being rotated to the same positionsor to new, preferred positions with the final prosthesis beingfabricated and seated on the abutments.

In certain embodiments, the transitional, preformed multifunctionabutments are replaced with milled ones that provide preferred contours,refined changes in position, gingival architecture, and otherimprovements when inserting the final screw retained prosthesis. Inother situations, milled, Universal Multifunction Abutments can bereplaced with milled Universal Contour Abutments at the restorativedentist's option, since they are interchangeable by virtue of theUniversal Automated and/or Interactive Clinical and/or Digital Protocol.It does not matter whether they are seated on an adaptor or an implantor whether the crowns are cemented or screw retained.

A steriolithograph or other CT scan software generated model can be usedwith a removable, rotatable aligning analog that is used in combinationwith the overlaying abutment or other prosthetic component to repositionthe abutment such that its primary indicium is repositioned in the mouthas it is on the universal aligning analog, using the adaptor's primaryindicium to direct that repositioning.

VI. The Universal Impression System

There are at least six possible methods for taking impressions orintraoral scans with the universal impression system or scanning system,and FIGS. 70-83 illustrates four of them. These methods are placing theimpression or scan post on the universal aligning adaptor (FIGS. 70-75 )with its primary indicium overlaying that of the adaptor; placing theimpression or scan post directly on the indexed healing cap with theirprimary indicia overlaying each other, but without having to remove thehealing cap (FIGS. 66-67 and 32-37 ); removing a previously placedtemporary abutment, inserting an indexed healing cap with matchinggingival contours and placing an impression or scan post on it with itsprimary indicium overlaying that of the adaptor (FIG. 76 ); inserting animpression or scan post on the cone of the universal multifunctionabutment (FIG. 82 ) such that its primary indicium overlays the primaryindicium of the abutment at the flat side. A fifth method of taking animpression with or without a transfer coping on an unprepared, preformedabutment that has been previously rotated, aligned and synchronized suchthat aligning the primary indicium of the impression or scan post withthat of the abutment registers that ideally established position (notshown in these drawings). Finally, a sixth method, allows for thefabrication of a universal generated prosthesis off any model that wasfabricated by taking an implant impression at the fixture level; pouringup the model with implant fixtures analogs or replicas; insertingadaptors on the implant analogs or replicas, and rotating the adaptorsand appropriate abutments over the analogs as described for theintraoral insertion of adaptors, above. Additional details that arespecific for taking an intraoral scan are shown in FIGS. 84-92 , andFIG. 83 .

FIGS. 70-71 provide an exploded view of the impression post (604) withan internal channel (665) to receive a fixation screw (200) that isseated on the collar of the universal aligning adaptor (100) havingprimary indicia (120, 121) that has a registration coping (672) foroptional use during a direct impression. A registration coping with adifferent configuration can be used for the indirect (through the tray)technique, as well. The impression post has an internal index (in thiscase an octagon configuration) (661) that interfaces with the indexedprojection (in this case an octagon stud) of the adaptor and has acylindrical external shape (637) and a reference polyhedron, in thiscase a flat surface (611) with a primary indicium (621) overlying theprimary indicium of the adaptor (120, 121). FIG. 71 shows that theimpression post (604) is engaging the octagon (661) of the aligningadaptor (100) with their assembly seated on the implant (10) with theadaptor's primary indicia (120, 121) facing outward, and affixed to itby the fixation screw (200) that has been inserted in the channel (665).The collar (637) of the impression post (664) can be cylindrical or itcan have a gingival shape to fit the intended position of the impressionpost. Thus, as previously discussed with regard to the gingival collarsof other components of the described system, the gingival collars of theimpression post can be shaped for the mandibular contour, maxillarycontour, anterior contour, or medium or large posterior contour.

The registration coping (672) is seated on the impression post, and isincluded in each drawing for demonstration purposes only of a preferredembodiment, since the impression can be taken without using it (seeFIGS. 72-74 ). In addition, this embodiment of the impression post cancome in many different shapes and polyhedron styles and can have theprimary indicia of the adaptor set in relation to the impression postand scanning post in other locations, as well.

FIGS. 72-74 show an impression post (604) configured to receive aregistration coping (672) for taking a direct impression, and animpression post for either a direct impression or a “through the tray”impression (673) without the use of a registration coping. Impressionscan be taken with or without the registration coping. The impressionpost (604) can have a 0° reference indicia on its collar (621). Althoughshown on the collar, it is understood that the 0° reference indiciacould also be positioned on the flat (611) or even the matedregistration coping (672). Similarly, although shown with only the 0°reference indicia, it is understood that the impression post can haveadditional reference indicia.

FIG. 75 shows the insertion of the impression post (604)/registrationcoping (672) assembly being inserted on an adaptor that has been rotatedto a preferred position. If it was rotated to align and/or optimallyposition an abutment or healing cap, then the primary indicium orspecified polyhedron of the impression post will be situated such thatit is positioned over the primary indicium of the adaptor. Thetechniques shown in FIGS. 70-75 can even be performed if the surgeon orrestorative dentist inserts the universal aligning adaptor with itsprimary indicia randomly positioned without first being optimallysituated, since the universal aligning analog (FIG. 94, 171 ) can beremoved and rotated in 15° increments such that the abutment isrepositioned to an ideal situation on the model. FIGS. 76 and 77 showthe impression post being seated directly on two variations of anindexed healing cap without its removal from the implant and are nowready for the impression. In FIG. 76 , the impression post (602) with aninternal octagon (661) and a direct impression registration coping (672)is being inserted and engaging an external octagon (406) on the top ofthe healing cap, which, in this embodiment, replicates a medium sizedpremolar contour (433). Collectively, this is shown as a universalimpression post over a healing cap (605). In FIG. 77 , anotherembodiment of the healing cap shows an exploded view of the engagementof the impression post (602) with a registration coping having engagingprotrusions (612) that are received in the recessed polyhedronreceptacles (408) of the contour healing cap (433).

FIGS. 78-81 show the impression post on an indexed healing cap whosegingival contours match the temporary abutment that has been removedfrom the adaptor and replaced with the indexed healing cap forimpression taking. FIG. 78 shows the removal of a medium sized premolartemporary abutment (333), which exposes the adaptor (100) as seen inFIG. 79 , and, in FIG. 80 , an indexed contour healing cap (433) ischosen that matches the gingival contours of the abutment and is seatedon the previously rotated adaptor. Since the adaptor is rotated aroundthe abutment into a preset position so that the abutment/adaptorassembly is optimally situated to within 7.5° of the ideal position ofan abutment in that configuration (e.g. molar vs. an incisor), and sincethe abutment and the indexed contour healing cap have their primaryindicia set in relation to the primary indicia of the adaptor, then theindexed contour healing cap will seat with the same relationship suchthat its primary indicium is also to within 7.5° of the idealconfiguration (see FIGS. 24A-D for the contour abutment rotation FIGS.58A-C, 59-61). In FIG. 81 the impression post (600) is then seated onthe indexed healing cap (433) with its primary indicium overlaying thatof the index, which is then secured with a fixation screw (200). FIG. 82shows an impression post (603) seated on a multifunction abutment (500)with the flat (611) and primary indicium overlying the primary indiciumof the abutment, which, in turn, has been rotated to be optimallysituated. This is the same technique used for taking an impression onthe previously rotated indexed healing cap. The impression posts andregistration copings are shown here for demonstration purposes and arenot limited as to size, polyhedron shape, or asymmetries or positioningrelative to their primary indicia. FIG. 83 shows the scanning postseated on the multifunction abutment with exactly the same relationshipas the impression post, after it has been rotated as in FIGS. 58A-61with its primary indicium and reference polyhedron directly over theprimary indicium of the abutment post, which is now in an optimallysituated position. The universal system has one set of impression postsfor all implants.

The techniques described in FIGS. 70-83 , above, are also used fortaking an intraoral or bench scan, since the universal scanning post andthe universal impression post are interchangeable on all of theuniversal platforms: on the aligning adaptor and analog, on an abutment,and on the indexed healing cap. They are interoperable, since allcomponents, via their primary and secondary indicia, are set in relationto the primary indicia of the universal aligning adaptor, no matter howit is positioned.

In certain embodiments in the process of dental restoration, animpression post assembly can be used. For example, a Universal AligningAdaptor can be seated on an implant that, at its bottom end, engages theimplant index, and on its top end has a polyhedron to engage animpression post. The adaptor and the impression post can haveco-operable indicia for identifying and registering the predeterminedposition of the adaptor the steps comprising a rotation of the adaptorand a prosthetic component also having co-operable indicia such that theprosthetic component establishes a preferred vertical and horizontalpredetermined position over the implant. The prosthetic component canthen be removed from the adaptor and an impression post seated on theadaptor such that the cooperable indicia of the adaptor and theimpression post register the newly established position of the adaptor.An impression can be taken to form a model for fabrication of a finalprosthetic component.

The primary indicium of the adaptor can be an engaging polyhedron whichprovides a positive seat when engaging the primary indicium of theimpression post possessing a mating polyhedron. The polyhedron at theprimary indicium of the adaptor can be a protruding sphere and thepolyhedron at the primary and secondary indicia of the impression postcan be a reciprocal, concave sphere.

The impression post can have an external polygonal configuration that isset in relation to its primary indicium and defines its insertion in theimpression after its removal from the mouth, such that the adaptoranalog is connected to the impression post as defined by therelationship of their primary indicia and the assembly is insertedinside the impression, which references the position of the primaryindicium of the adaptor.

An impression coping having a primary indicium and an internalconfiguration that matches to the external configuration of theimpression post can be seated on the impression post such that theirprimary indicia are synchronized prior to taking the impression, whichreferences the primary indicium of the adaptor when it is incorporatedinto the impression after the impression is taken. The impression copinginside the impression can receive the impression post after it has beenconnected to an adaptor analog with their primary indicia overlying eachother with the assembly then being poured as part of a working model. Incertain embodiments, the impression coping can protrude through the trayfor use in an indirect impression technique.

In certain embodiments, connecting rods can be affixed to impressioncopings prior to taking an impression of the universal aligning adaptorsseated on multiple implants in order to better stabilize them duringmodel fabrication. The impression post/base assembly being connected tothe universal aligning analog translates the gingival contours andconfigurations established during tissue training by the insertedhealing cap or temporary abutment to the pattern used for the final castabutment or to the software program whose milling device codes andcontrols create the milled abutment or other prosthetic device.

The final abutments can be fabricated from preferred castable orpressable patterns when they are cast or pressed using a suitablecasting metal or pressable material, identical preformed abutments thatare inserted on the working model when simplicity is desired, orfabricated from the data conveyed to a milling program from a bench scanof the working model when milled abutments are preferred.

In certain embodiments, an interim prosthetic device can be used todetermine the ideal, predetermined position of a future final prostheticdevice that is seated on an adaptor's top end. An impression post havingco-operable indicia for identifying and registering that predeterminedposition of the interim prosthetic device can be used. The impressionpost can be situated in relation to the position of the interim abutmentover the implant.

In certain embodiments, rotation of the adaptor and the interimprosthetic device via their co-operable indicia can be performed suchthat the interim prosthetic device is positioned in a preferred verticaland horizontal predetermined position over the implant. Afterward, animpression post can be seated on a polyhedron on the top end of theprosthetic device which has been configured to synchronize with theprimary indicia of the adaptor and, thereby, register the adaptor'snewly established position.

The primary indicium of the prosthetic device can be located on thepolyhedron of the indexed prosthetic device which is in line with theprimary indicium of the healing cap. In this configuration, the alignedindicium identify the preferred vertical and horizontal predeterminedposition.

The primary indicium on the polygonal structure can be an engagingpolygonal structure which provides a positive seat for engaging theimpression post with a reciprocal polygonal structure that aligns theirrespective primary indicia. In certain embodiments, the polyhedron onthe bottom end of the prosthetic device is an index with the samepolygonal configuration as the index of the underlying adaptor such thattheir polygonal sides are aligned. For example, the polyhedron on thebottom end of the prosthetic device is an octagon when the adaptor's topend is also an octagon, or is a hexagon when the open end of the adaptoris also a hexagon.

The prosthetic device can be a gingivo-adaptor which is a prostheticdevice comprising a one-piece assembly of an adaptor stud on its openend and the configuration of an implant engaging stud on its free endsuch that the open end index receives the impression post.

In one aspect of taking an impression of a multifunction abutment, anassembly for use in the process of dental restoration relevant to dentalimplant prosthetics can include an adaptor, a multifunction abutmentseated on the adaptor's open end which will, in turn, receive a screwborne prosthesis on its own open end and an impression post havingco-operable indicia for identifying and registering the predeterminedposition of the multifunction abutment, which has been situated inrelation to the cooperable indicia of the adaptor. The operable stepsinclude rotation of the adaptor and the multifunction abutment, alsohaving co-operable indicia, such that the multifunction abutment issituated in a preferred vertical and horizontal predetermined positionover the implant. Next, an impression post can be seated on a screwbearing polyhedron on the open end of the abutment that receives thescrew borne prosthesis such that the cooperable indicia on the screwbearing polyhedron and those on the impression post together registerthe newly established position of the multifunction abutment, which, inturn, has been set in relation to the adaptor's cooperable indicia.Next, an impression can be taken to form a model for the fabrication ofa final prosthetic device.

In certain embodiments, co-operable indicia includes primary andsecondary indicia such that the primary indicia of the multifunctionabutment, which is set in relation to the primary indicium of theadaptor and the primary indicium of the impression post, determine theproper seating of the impression post. The primary indicium of themultifunction abutment and impression post can overlie each other.

In certain embodiments, a screw bearing polyhedron can be used with themultifunction abutment. In such an embodiment, an engaging polygonalstructure provides a positive seat for engaging the impression post witha mating polygonal structure that aligns their respective primaryindicia.

The impression post can have an external polygonal configuration that isset in relation to its primary indicium and to that of the multifunctionabutment. The external polygonal configuration can define the insertionof the impression post in the impression such that the multifunctionabutment analog is inserted inside of it in the same manner as theabutment, which references the position of the primary indicium of themultifunction abutment, and, thereby, the adaptor, as well.

An impression coping having an internal configuration that matches tothe external configuration of the impression post can be seated on theimpression post on the previously inserted multifunction abutment priorto taking the impression such that the coping's primary indiciumoverlies the primary indicium of the impression post, which, in turn, issuperimposed over the primary indicium of the abutment such that it isthen incorporated in the impression when the impression tray is removedfrom the mouth.

The impression coping seated in the impression can receive theimpression post after it has been connected to a multifunction abutmentanalog such that its primary indicium is in its preferred position andthe primary indicium of the analog is located at the same secondaryindicium position as the corresponding adaptor when seated on theimplant, and the assembly is incorporated in the working model when itis poured.

In another aspect of taking an impression of a preformed, unpreparedcontour abutment with a predetermined tooth preparation and a desiredgingival configuration at its bottom end, an impression coping havingco-operable indicia for identifying and registering the predeterminedposition of the contour abutment is used to register the abutment afterit has been set in relation to the cooperable indicia of an adaptor canbe used. The adaptor and the contour abutment can be rotated via theirco-operable indicia such that the contour abutment is situated in apreferred vertical and horizontal predetermined position over theimplant. An impression coping can then be seated on the abutment suchthat the cooperable indicia on the impression coping and the abutmentpost register the newly established position of the contour abutment,which has been set in relation to the adaptor's cooperable indicia. Animpression can then be taken to form a model for fabrication of a finalprosthetic device to fit on the preformed abutment.

In certain embodiments, another preformed abutment post can be directlyinserted in the impression or inside the impression coping and the finalprosthesis fabricated, when the abutment is satisfactory as is and hasnot been prepared.

The impression coping can be fabricated of a suitable restorativematerial and can be used after the model is poured to serve as a crownor other prosthetic device coping and, thereby receive the appropriateveneering material.

The Universal 3D Imaging, and Milling System

The Universal System is capable of digitally registering an implant viaan intraoral or bench scan or a CBCT scan. The terms, “imaging” or “3DImaging”, are used when referring to all three scans. Each of the threescans has a scan post that is either seated on an adaptor or on anindexed healing cap prior to taking the scan.

FIG. 84 is a frontal view of the universal scanning post seated on auniversal adaptor for taking an intraoral scan or a CBCT scan. It canalso be seated on an adaptor analog or on an adaptor, which, in turn, isseated on an implant analog, either of which is seated in a model fortaking a bench scan. In the embodiment shown in FIG. 84 , the universalscanning post (700) with a polyhedron (715) is seated on the adaptor(100), both of which are connected to the implant (10) with a fixationscrew (200). In FIGS. 85A and 85B show the scanning post (700) and itsprimary indicia, (713) and (714), and its secondary indicium (715). InFIG. 85A, the scan post is being rotated so that its primary indicia,(713) and (714) will be directly over the primary indicia of thealigning adaptor (120, 121) as shown in FIG. 85B. This figure shows arecessed octagon index (661) that engages the octagon protrusion of theadaptor in the mouth, or on an adaptor analog seated in a model. In FIG.17B(2), the first primary indicium is an “X” sphere (713) located overthe primary indicia of the adaptor (120, 121), the second primaryindicium is a “Y” rectangle (714) located vertically a set distance fromthe “X” sphere (713), and the secondary indicium is a “Z” triangle (715)located in a different plane, in this case, opposite the “X” spherehaving been seated on an adaptor. In certain embodiments, the “Z”triangle (715) is located directly or 180° behind the “X” sphere and the“Y” rectangle (714) is an equal distance from the “X” sphere. However,the scanning post can have any number of markings or polyhedrons ofvarying configurations and relationships to each other and to theprimary indicium of the adaptor, itself, for the scan to be taken, sincethe scan code has the necessary information to register the location,angulation, rotation points, anatomic contours, and other pertinentinformation in relation to the configuration of the scanning posts. Inshort, the potential embodiments of the universal scan postconfiguration are not limited by the descriptions shown here. FIG. 17Bshows the universal scan post being seated on a previously rotatedadaptor prior to taking an intraoral scan or on analogs in a modelbefore completing a bench scan. In certain embodiments, the same postcan be used for both the intraoral and bench scan, but the intraoralscan post can have a different design than the bench scan post, becausethey are synchronized via their relationship to the reference points ofthe adaptor (primary indicia). In this example, the universal scanpost's “X” and “Y” polyhedrons are being seated over the adaptor'sprimary indicia (120, 121), while in FIGS. 86 and 87 , the universalscan post's “X” and “Y” polyhedrons are being positioned over theprimary indicium of the healing cap (421) and the projections (712) areseated in the recesses (412) in the healing cap that serve as theconnecting index. These polyhedrons are not limited by this embodiment,which can, for example, be reversed with projections on the healing capand recesses in the scan (or impression) post. As in the impressiontechnique shown in FIG. 71 , the healing cap does not have to be removedfor the intraoral scan to be performed, since the post is directlyconnected to it. FIG. 87 shows an exploded view of the connection of thescanning post with the indexed healing cap with the polyhedronprojections inserted in the matching recesses.

FIGS. 88-92 show additional embodiments of the indexed contour healingcap (401) that share a matching gingival contour (444, FIGS. 89-90 )with the temporary abutment (344, FIG. 89 ) that has been seated on thealigning adaptor. It has an aligning external index (406) which is ageometric and positional facsimile of the index of the underlyingadaptor, in this case, an octagon. Once again, any type of indexablepolyhedron can be used in this technique, including an internal octagon(not shown).

In certain embodiments, the indexed contour healing cap (401) has aprimary indicium on its collar (411) and on its top surface (421), andhas one on the index (428) which is in line with them. FIG. 88 ,illustrates a maxillary premolar temporary abutment with a scallopedgingival contour (344) that is seated on an aligning adaptor, whileFIGS. 89-90 shows that temporary abutment and an indexed healing caphaving the same gingival contour (344, 444). FIG. 91 shows an indexedcontour healing cap being rotated until position “b” is overlaying theadaptor's primary indicium (120), which centers its primary indicium(421) in relation to the jaw. The scanning post (700) is now seated onthe indexed contour healing cap (401) such that its primary indicia(713) and (714) overlay the primary indicia of the healing cap (428) and(421), which is then secured with a fixation screw. The intraoral orbench scan will now capture the angle and index alignment of theimplant, the type of preformed gingival architecture being used for thisimplant, and the soft tissue relationship to the preformed gingivalarchitecture. The CBCT scan will capture the absolute position of theprimary indicia of the scan post (713) and (714) and the indexed contourhealing cap in relation to hard jaw structures (such as bone, teeth, andimplant fixtures), and create a set positional relationship of thosestructures to the scan post (700). The intraoral or bench scan imagescan now be merged to the CBCT image using the scan posts' polyhedronprimary indicia (713) and (714), as well as the geometry of the chosenhealing cap (401). The technician can now fabricate a milled finalabutment and crown (or other restorations) with the geometry of thegingival base already preset to that of the chosen contour healing cap,or can have models fabricated to create lab processed restorations. Ofcourse, if the indexed contour healing was placed instead of thetemporary abutment, then an intraoral scan is performed and the finalrestorations can be fabricated without even having to remove it.

In certain embodiments, all scanning posts for taking an intraoral,CBCT, or bench scan have the same configuration, although they will havevarying compositions, depending upon the type of scan being taken. Giventhe fact that the scan post polyhedrons shown in the examples above areeither primary (713) and (714) or secondary indicia (715) and given thefact that they are positioned either directly over the primary indiciaof the aligning adaptor (120, 121), or the primary indicia of theindexed healing cap (428), which has been set in relation to the primaryindicia of the aligning adaptor (120, 121), the merging of the intraoralor bench scan images with the CBCT scan image is automatable as thepolyhedrons can automatically stitched together by combining themultiple reference points, once the location of the adaptor primaryindicium, implant angulation, position in the jaw, and other appropriatedata are input into via the Universal System scan code into the program.

Milling Abutments and Prosthetic Devices

For the purposes of discussion in this application, the terms “milledabutments” or “milling” connote any computer generated method forfabricating prosthetic components and devices to fit over implants,including, but not limited to, CNC milled components, stereolithographygenerated components, and other components.

In certain embodiments, an imaging post assembly can be used forfabricating milled abutments and prosthetic devices. The imaging postassembly can comprise an adaptor seated on an implant such that theadaptor index at its bottom end engages the implant's index. The imagingpost can be seated on a polyhedron on the top end of the adaptor suchthat the adaptor and the imaging post have co-operable indicia fordigitally identifying and registering the predetermined position of theadaptor. For example, a prior rotation of the adaptor and a prostheticcomponent also having co-operable indicia can be performed such that theprosthetic component establishes the preferred vertical and horizontalpredetermined position over the implant. The prosthetic component canthen be removed from the adaptor and the imaging post can be seated onthe adaptor such that the cooperable indicia of the adaptor and theimaging post register the newly established position of the adaptor whentaking an intraoral scan or similar scan. From this digital data, anabutment configuration can be rendered and conveyed to the millingprogram for abutment fabrication. Co-operable primary and secondaryindicia can be used such that the primary indicia of the adaptor andimaging post determine the proper seating of the imaging post. Theprimary indicium of the adaptor and the imaging post can overlie eachother.

The primary indicium of the adaptor can be an engaging polyhedron whichprovides a positive seat when engaging the primary indicium of theimaging post having a mating polyhedron.

The primary indicium position of the adaptor can be translated to achosen milling program for creating a milled abutment, other prostheticdevice, and/or prosthesis framework. The milling program uses theprimary indicium position as part of the milling code for themanufacturing of the milled abutment, other prosthetic device, and/orprosthesis framework. For example, the primary indicium position informsthe milling code how to control the milling process to thereby properlyorient the manufactured item when seated on the adaptor or directly tothe implant such that the manufactured item is properly, aesthetically,aligned.

In addition to the adaptor's primary indicium, the primary and secondaryindicia of the abutment can be translated to the milling code of amilling software program. In such a manner, an ideally positionedvirtual abutment or prosthetic device can be rendered first in thesoftware and then integrated with the milling device codes and controlsof a software program for the manufacture of a physical abutment orprosthetic device.

In certain embodiments, the abutment or prosthetic device can bemanually rotated with the adaptor within the program by a user to apreferred position on the adaptor. In other embodiments, the software isprogrammed to automatically rotate the abutment or prosthetic devicewhen the data input indicate the location of the primary indicium of theadaptor in relation to the primary or secondary indicia of the abutmentor prosthetic device. In other instances, the universal automated and/orinteractive digital protocol is translated to a milling softwareprogram, after taking an intraoral, bench, or CBCT scan that identifiesthe index align

In certain embodiments, the imaging post has one or more markings orpolyhedrons that are identifiable by the scan code of the programfabricating the milled abutment. For example, the markings orpolyhedrons are enhanced by a substance that is readily visualized bythe intraoral or bench scanner such as titanium dioxide or othersuitable material, and may be enhanced by using barium or other suitablematerial for the CBCT X-ray scanner. In other embodiments, the imagingpost has similar or dissimilar scanner identifiable polyhedrons whichare located in an X-Y-Z plane to facilitate the virtual positioning ofthe implant abutment and the adaptor via the program's scan code. Forexample, the imaging post can have dissimilar scanner identifiablepolyhedrons in the X-Y-Z plane such that the polyhedron in the “Z”location is 180° and a set distance from the “X” polyhedron as partiallydetermined by the thickness of the imaging post and the “Y” polyhedronis a set 90° vertical distance from the “X” polyhedron that facilitatesthe scan process and accuracy. In at least certain embodiments, theimaging post's “Z” and “Y” scanner identifiable polyhedrons are the samedistance from the “X” polyhedron which defines a precise isoscelestriangle.

The Indexed Healing Cap and 3D Imaging

The indexed healing cap can be used to register the adaptor's referenceindicium as well as the preferred gingival architecture that wasdeveloped by the geometry of the previously inserted healing cap.

In certain embodiments, an indexed healing cap or other referencingprosthetic component can be used to determine the ideal, predeterminedposition of a future final abutment or other prosthetic component thatis seated on an adaptor's top end, and an imaging post havingco-operable indicia for digitally identifying and registering thatpredetermined position of the healing cap or other prosthetic component,after rotation to the preferred vertical and horizontal predeterminedposition over the implant. This can involve the rotation of an adaptorand the healing cap or other prosthetic component via their co-operableindicia such that the healing cap or other prosthetic component ispositioned in a preferred vertical and horizontal predetermined positionover the implant. Then an imaging post is seated on a polyhedron on thetop end of the healing cap which has been configured to synchronize withthe primary indicia of the adaptor, which registers the adaptor's newlyestablished position.

The co-operable indicia can include primary and secondary indicia suchthat the primary indicia of the healing cap, which is set in relation tothe primary indicium of the adaptor, and the primary indicium of theimaging post, determine the proper seating of the imaging post. Theprimary indicium of the indexed healing cap can be identified by itspreferred vertical and horizontal predetermined position and designatesthe insertion point of the imaging post.

The primary indicium of the indexed healing cap can be located on thepolyhedron of the indexed base unit of the referencing device which isin line with the primary indicium that is identifying its preferredvertical and horizontal predetermined position. The primary indicium onthe polygonal structure can engage a polygonal structure which providesa positive seat for engaging the imaging post with a reciprocalpolygonal structure that aligns their respective primary indicia. Thepolyhedron on the end of the prosthetic device can be an index with thesame polygonal configuration as the index of the underlying adaptor suchthat their polygonal sides are aligned. The polyhedron on the end of theprosthetic device can, for example, be an octagon when the adaptor'sopen end is also an octagon, or is a hexagon when the open of theadaptor is also a hexagon.

The indexed healing cap can have either symmetrical or asymmetricalcontours such as cylinders, conical cylinders, or custom contours thatextend from its free end to its open end as it emerges from the implantthrough the gingiva to the free gingival margin over the implant. Theindexed healing cap has been previously situated in combination with anadaptor over an implant such that the restorative dentist can registerthe position of the adaptor via an intraoral, bench, or CBCT scanwithout removing the healing cap from the implant. The prosthetic devicecan also be a gingivo-adaptor which is a prosthetic device comprising aone-piece assembly of an adaptor stud on its end and the configurationof an implant engaging stud on its end such that the end index receivesthe impression post.

The primary indicium of the indexed healing cap can therein be conveyedto the milling device codes and controls to the chosen milling programfor creating a milled abutment or other prosthetic device and prosthesisframework. The abutment or prosthetic device can be milled such that thescan code incorporates the location of the primary and secondary indiciaof the ideally positioned virtual abutment and integrates it with themilling device codes and controls of a software program.

As previously explained, the abutment or prosthetic device is eithermanually rotated with the adaptor within the program to ideally positionit or automatically rotated when the data input indicate the location ofthe primary indicium of the adaptor in relation to the primary orsecondary indicia of the abutment or prosthetic device. The imaging postcan have one or more markings or polyhedrons that are identifiable bythe scan code of the program fabricating the milled abutment.

The indexed healing cap can have the same gingival contours as theinterim healing cap or temporary abutment, which are also identifiableby the universal scan code from a library, and translates thatinformation towards either choosing the correct base for the castable orpressable abutment or inserting the data in the scan code's millingdevice codes and controls of a software program used when creating themilled abutment.

Scanning the Preformed Unprepared Abutment:

Further embodiments provide an assembly for use in the process of dentalrestoration relevant to dental implant prosthetics comprising anadaptor, a preformed, unprepared contour abutment with a predeterminedtooth preparation and a desired gingival configuration at its end, and acoping having co-operable indicia for digitally identifying andregistering the predetermined position of the contour abutment, whichhas been set in relation to the cooperable indicia of the adaptor. Thisprocedure can involve the rotation of the adaptor and the contourabutment also having co-operable indicia such that the contour abutmentis situated in a preferred vertical and horizontal predeterminedposition over the implant. An imaging coping can be seated on theabutment such that the cooperable indicia on the imaging coping and thescan post register the newly established position of the contourabutment, which has been set in relation to the adaptor's cooperableindicia. In this position, a scan can be taken for fabrication of afinal prosthetic device to fit on the preformed abutment.

In certain embodiments, the scan coping has the appropriate data formilling the abutment which has a matching configuration to its internalconfiguration. The scan data can include the configurations of thetemporary abutment that holds the scan coping.

The abutment or prosthetic device can then be milled from the scan codeincorporating the location of the primary and secondary indicia of theideally positioned scanned abutment.

Scanning the Multifunction Abutment:

Further embodiments provide an assembly for use in the process of dentalrestoration relevant to dental implant prosthetics that can include anadaptor, a multifunction abutment seated on the adaptor's end and aimaging post having co-operable indicia for digitally identifying andregistering the predetermined position of the multifunction abutment,which has been set in relation to the cooperable indicia of the adaptor.The multifunction abutment can receive a screw borne prosthesis on oneend. In certain embodiments, the adaptor and the multifunction abutment,also having co-operable indicia, can be rotated such that themultifunction abutment is situated in a preferred vertical andhorizontal predetermined position over the implant. Once properlysituated, an imaging post can be seated on the end of the abutment thatreceives the screw borne prosthesis such that the cooperable indicia onthe screw bearing polyhedron and those on the imaging post togetherregister the newly established position of the multifunction abutment,which has been set in relation to the adaptor's cooperable indicia. Inthis position, it is possible to take a scan for the fabrication of afinal prosthetic device.

In one aspect, the co-operable indicia can include primary and secondaryindicia such that the primary indicia of the multifunction abutment,which is set in relation to the primary indicium of the adaptor and theprimary indicium of the imaging post, determine the proper seating ofthe imaging post. The primary indicium of the multifunction abutment andimaging post can overlie each other.

In a further aspect of the invention, the primary indicium on the screwbearing polyhedron of the multifunction abutment can have an engagingpolygonal structure which provides a positive seat for engaging theimaging post with a mating polygonal structure that aligns theirrespective primary indicia.

The primary indicium of the adaptor can be conveyed by its scan code'smilling device codes and controls to the chosen milling program forcreating a milled abutment or other prosthetic device and prosthesisframework. The abutment or prosthetic device can be milled from the scancode incorporating the location of the primary and secondary indicia ofthe ideally positioned virtual abutment are integrated with millingdevice codes and controls of a software program. The abutment orprosthetic device can be either manually rotated with the adaptor withinthe program to ideally position it or it can be automatically rotatedwhen the data input indicate the location of the primary indicium of theadaptor in relation to the primary or secondary indicia of the abutmentor prosthetic device.

The scan post can have one or more markings or polyhedrons that areidentifiable by the scan code of the program used to fabricate themilled abutment. The markings or polyhedrons can be enhanced by asubstance that is readily visualized by the scanner such as titaniumdioxide or other suitable material. The scan post can have similar ordissimilar scanner identifiable polyhedrons which are located in anX-Y-Z plane to facilitate the virtual positioning of the implantabutment and adaptor via the program's scan code. In certainembodiments, the scan post has dissimilar scanner identifiablepolyhedrons in the X-Y-Z plane such that the polyhedron in the “Z”location is 180° and a set distance from the “X” polyhedron as partiallydetermined by the thickness of the scan post and the “Y” polyhedron is aset 90° vertical distance from the “X” polyhedron that facilitates thescan process and accuracy. The scan post's “Z” and “Y” scanneridentifiable polyhedrons can be the same distance from the “X”polyhedron, which defines a precise isosceles triangle.

In addition to an intraoral scan, a CBCT scan can be performed in thesame manner, although the CBCT scan post is composed of a nonmetallicmaterial to prevent X-ray scatter. In a preferred technique, the CBCTand the intraoral scans can be merged by overlaying their referencingpolyhedrons, etc.

In certain embodiments, an impression is first taken of the implantusing the impression post of the company supplying the implant and amodel is poured using an implant replica. A bench scan is then taken, byseating a universal scan post on an implant replica such that itcaptures the implant's index relationship, which is translated to asoftware program having the universal automated and/or interactivedigital protocol within the universal scan code which virtually rotatesan abutment into a preferred position. In another embodiment, an adaptoris first seated on the implant replica with a referencing post thenbeing used to determine the ideal position of an abutment on the modelprior to removing the referencing post and placing the scan post suchthat its primary indicium is set in relation to the primary indicium ofthe adaptor. A bench scan is then performed with the data translated tothe milling software program for the fabrication of the milledprosthetic components. In another embodiment, a CBCT scan can be takenand the bench scan polyhedrons can be merged with those of the CBCTscan, thereby eliminating any error resulting from any inaccurateimpression. The CBCT scan registers the absolute position of theuniversal aligning adaptor's primary indicium (and, therefore, theimplant's index alignment).

The Universal Automated and/or Interactive Clinical and/or DigitalProtocol:

The Universal Automated and/or Interactive clinical and/or digitalprotocol is a translational, integrating treatment protocol and makesuse of cooperable componentry to synchronize them to a primary referencepoint.

One embodiment provides a method of restoring an implant having anyindex configuration and alignment by realigning, synchronizing, andreferencing all restorative prosthetic components to set referencepoints wherein an automated and interactive clinical and/or digitalprotocol is used to realign and synchronize an implant prosthetic insertand a prosthetic component via their co-operable indicia such that theprosthetic component is situated in a preferred, predetermined position,which ideally situates its subgingival and supergingival configurations.The surgeon can select the desired vertical angle correcting prostheticcomponent having the appropriate geometric shape for restoring theimplant. The prosthetic component can be rotated over the prostheticinsert via their co-operable indicia in relation to each other such thatthe prosthetic component is ideally situated. Once ideally situated, theco-operable indicia at that position can be identified and referenced.The identified, reference positions serve as reference points forfabricating the final prosthetic components and devices.

In certain embodiments, the co-operable indicia include graduatedreference points and/or a mechanism of primary and secondary indiciathat establish the rotation and synchronization points.

The implant prosthetic insert can be an adaptor whose primary indiciumis one of the reference points that define the synchronization of allother prosthetic components as well as their relationship to theimplant's index.

In certain embodiments, all other componentry are synchronized to theprimary indicium of the adaptor, to the specific primary or secondaryindicium of the prosthetic device that overlays the primary indicium ofthe adaptor, and to the primary indicium of the prosthetic componentwhich defines its preferred horizontal and vertical position.

The adaptor and the prosthetic component can be rotated about each othersuch that the primary indicium of the prosthetic component is alignedwith a particular primary or secondary indicium of the prostheticcomponent when it is situated in a predetermined, preferred horizontaland vertical position. The adaptor and the prosthetic component can bepositioned such that the primary indicia of the adaptor and the abutmentoverlay each other when no rotation was performed, and a specificsecondary indicium of the abutment overlays the primary indicium of theadaptor as determined by the degree of horizontal rotation that wasnecessary.

The rotation of an abutment or other prosthetic component to itspreferred position synchronizes its primary and secondary indicia inrelation to the primary indicia of the adaptors, thereby, the indexes ofthe implants, including the referencing devices such as an impressionpost or a scanning or imaging post or CT scan post, which automatesimpression taking or 3D imaging.

In certain embodiments, identifying the rotation and synchronizationpoints prior to taking an impression for a bench scan, automaticallyidentifies and references them during the bench scan, and, thereby,lessens the effects of any distortion that can occur from expansion andcontraction of materials, when taking an impression for fabricating amodel.

One embodiment provides a method of restoring any implant with any indexconfiguration and/or misalignment which is positioned at any verticalangulation, wherein an aligning, synchronizing, referencing devicedefines the preferred, predetermined position of an interim or finalprosthetic component or device such that it is ideally situated. In suchan embodiment, an aligning, synchronizing, referencing device can beused in combination with an automated and interactive clinical and/ordigital protocol to realign the referencing device to an ideal position,wherein the device is composed of an adaptor and an abutment havingco-operable indicia that permits them to be rotated relative to eachother to identify the abutment's preferred position. All otherco-operable componentry can be synchronized to the newly repositionedcooperable indicia. The synchronized indicia can be used to registerthat position. Using the registered position information, the finalprosthetic components and devices can be fabricated according to thosereference points.

The co-operable indicia can include graduated reference points and/or amechanism of primary and secondary indicia such that the primaryindicium of the adaptor is rotatable in relation to the primary andsecondary indicia of the abutment as defined by the desiredpredetermined position. The automated and interactive clinical and/ordigital protocol can include a plurality of realigning and synchronizingprosthetic components and/or establishing or refining the gingivalcontours of interim or final prosthetic components, such that they areideally situated, for replicating the tissue contours established byinterim prosthetic components during the tissue engineering phase.

The chosen prosthetic component is rotated in either a predeterminedclockwise or counterclockwise direction over an adaptor such that theprimary indicium of the adaptor is positioned at a particular primary orsecondary indicium of the prosthetic component, with the primary indiciaof both components now being situated in relation to the index of theimplant.

The realignment of the abutment or other prosthetic component orprosthesis can be preformed clinically in the treatment room or on thelaboratory bench or is done virtually within a software program.

The aligning, synchronizing, referencing device can also serve as aninterim abutment, healing cap or other interim prosthetic component. Theabutment can be preformed, cast, milled or fabricated by anotherprosthetic means and is used for restoring a crown, bridge, or set ofcrowns with a preferred emergence profile, angulation, tooth preparationform, gingival architecture or other aspects for creating a preferredcrown, set of crowns, bridge or similar prosthesis.

The abutment can also be preformed, cast, pressed, milled or fabricatedby another prosthetic method and is used to restore an implant with ascrew down prosthesis, wherein the repositioning of the abutment ideallypositions the screw access channel for receiving the prosthesisanchoring screw.

The final aligning, synchronizing, referencing device can also be usedto ideally position an implant during insertion. It is seated in theimplant prior to its final torqueing during its insertion to assess thealignment of the index so that it can be ideally situated as the implantis tightened.

Universal Aligning Analog

FIG. 18 shows a universal aligning analog (171), which is the idealanalog for the laboratory fabricated model or the CT scan generatedmodel because, in certain embodiments, it repositions an abutment byrotating it in 15° increments; is antirotational in the model; can beremoved, rotated and reinserted accurately to create that 15° horizontalrotation; can internally receive a set screw, and can be used forrestoring any implant. In combination with the universal impressionpost, it provides mistake free models that are particularly effectivewhen creating one piece castings and milled frameworks. In certainembodiments, the aligning analog has a shank with an externalconfiguration (173) which has the same type of polygonal configurationas the index of the implant, which, in the exemplified case of FIG. 94 ,is an external hexagon which is an external version of the internalhexagon index of the implant. The top of the analog is a dissimilarindex that receives an abutment or healing cap, which allows the analogwith the abutment or healing cap to create a rotation that replicatesthe rotation that is accomplished with an universal aligning adaptor andabutment. When the top of the analog is an octagon (111), it is intendedfor use with trichannel, hexagon, and dodecagon implants, which can nowbe finely rotated about the vertical axis, achieving an optimalpositioning of the abutment within a maximal 7.5° deviation from theideal direction. This embodiment is not limited to an octagon/hexagoncombination shown here, but, rather, the top configuration and the shankconfiguration can be any combination of dissimilar polyhedrons that willcreate a rotation as noted above in some other set increment of degreesof horizontal rotation. For example, a dodecagon (12 sided) shank couldbe used with the octagon index on top in order to achieve a 7.5°horizontal rotation, or, if the implant has an internal octagon, theshank of the analog is an octagon or hexadecagon, but the stud thatreceives the abutment is a hexagon, which is the same relationshipdescribed above for the adaptor seated on an octagon indexed implant.Once again, this external polyhedron also serves as an antirotationaldevice when the analog is seated in the model. In the embodiment shownhere, the “implant” hex hole is either created when the model is pouredaround the analog or is created in the model when milled, fabricated bystereolithograph, or other method, which, in this case, is a hexagon,but can be any type of polyhedron. In an additional embodiment, theanalog has one or more internal screw holes (174) that are at an angle(as much as 90°) to the shank, which allows them to receive a set screwwhich provides additional retention and prevents vertical movement.

FIG. 93 shows a 30° angle correcting multifunction abutment seated on auniversal aligning analog (171) having an external configuration (173)that, in this case, is a hexagon. FIGS. 94 and 95 provide arepresentation of either a poured model with universal aligning analogsin them or a CT scan generated image showing the “placement” of theanalogs according to the surgeon's preferences. In this case, theimplant in tooth position #22 has its center line (528) angled towardsthe distal solder joint, rather than in the ideal position (529). FIG.96 shows that the rotation of the analog one stop of the its hexagonshank has turned the necessary 15° to situate the abutment (529) withinthe anatomic crown of tooth #22. This ability to achieve a finitehorizontal rotation fosters the fabrication of a full arch bridge withscrew access holes ideally positioned towards the central axes of thereplacement teeth on the prosthesis, or allows a full arch set of milledabutments to be created with an improved emergence profile, since themilling machine has to cut less of the abutment from the mesial ordistal sides as it parallels them. Thus, the above figures show that theimplant in the tooth #27 position does not require any rotation tocenter it (528).

The universal aligning analog can be used interchangeably with theuniversal contour abutment system and the universal multifunctionabutment system, and can be cross transferred from a model of implantreplicas so that universal system components can be used to fabricatethe restorations.

The co-operable indicia can include primary and secondary indicia suchthat the primary indicium of the adaptor is rotatable in relation to thesecondary indicium of the abutment as defined by the desiredpredetermined position and the location of the abutment's primaryindicium determines the location of the fixation screw threads.

The adaptor can be rotated around the abutment and the assembly isrotated over the implant such that the primary indicium of the adaptoris aligned with a specific primary or secondary indicium of the abutmentwhen it reestablishes the preplanned, preferred position of themultifunction abutment to compensate for implant index misalignment, andthe screw thread is positioned approximately 180° from the primaryindicium.

In another method, the adaptor can be first rotated over the implant toa predetermined position with the abutment then inserted over theadaptor in its preferred position.

The Universal Aligning Tool

FIGS. 97A-D reveal a carrier/aligning tool that is used to positionand/or rotate an adaptor into an abutment. In this embodiment an adaptorcarrier (815) with a releasing screw tool (818). Another embodiment canhave the carrier without the releasing screw or vice versa. In FIG. 97A,the carrier has a primary indicium (816) that is positioned in line withthe primary indicia (120, 121) of the adaptor to allow it to repositionit in line with a secondary indicium of the abutment to position (a)(525) as shown in FIG. 97B. In certain embodiments, there is a way onthe adaptor for a positive seat of the holder, which, in this case, isthe primary indicium of the adaptor that is engaged by the holdingtool's primary indicium. FIG. 97C shows the aligning adaptor having beenrotated with the carrier's primary indicium (816), which overlays theprimary indicium of the adaptor, to position “a” (secondary indicium,525) to achieve a predetermined horizontal rotation. FIG. 97D shows theturning of a releasing screw (818) into threads inside of the abutmentsuch that it releases the abutment from the adaptor (100) as it bottomsout in the carrier.

The Universal Aligning, Synchronizing Implant

FIGS. 98 and 99A-B show the nonagon implant which has a nine sided indexwith a vertex or situating primary reference indicium, and, which, incombination with a universal aligning adaptor, provides an absolute 5°horizontal rotation of all healing caps, abutments, impression posts,scanning posts, and other restorative components that are misaligned bythe implant's index. This makes the nonagon the ideal implant forpositioning and situating of healing caps, abutments, impression posts,scanning posts, and other restorative components. FIGS. 98 and 99A-Bshow an abutment post being inserted over the primary indicium (111) ofits octagon stud, which, in turn, overlies the vertex (145) of thenonagon stud at its base, which is inserted into the nonagon index ofthe implant at its vertex (920). As such, the vertex (145) serves as theimplant's primary indicium, and, in this example, the abutment (300) isbeing inserted without any rotation, presumably because the implant'sindex is situated in relation to a sagittal plane that bisects the ridgeof the jaw at its individual center point. FIG. 100A shows an implantfixture mount, (930) having a primary reference vertex (932) overlyingthe primary reference vertex (933) of the nonagon male index (931) thatis connected to the internal nonagon index (901) of the implant, at itsown primary reference vertex (920). FIG. 100B shows the implant seated.FIG. 100C shows the implant's vertex (920) in line with a primaryindicium scribe line (921) on the collar of the implant. The vertex ofthe fixture mount (933) serves as a positional device that allows thesurgeon to precisely see when he is situating the implant so that a linedrawn through the implant in the sagittal plane bisects the ridge atthat point at approximately 90°. The vertex of the extender is itsprimary indicium or relational device. This invention of using thefixture mount as a relational device when seating an implant is notlimited to the nonagon implant, but, in fact, can be used with anyfixture mount having any polyhedrons on its shank which can be used tocenter the implant.

FIGS. 101 and 102 show a nonagon implant being seated such that thevertex of the fixture mount (933) and, therefore, that of the implant(920). Once inserted, if the nonagon index is not optimally situated inrelation to a sagittal plane that bisects the ridge of the jaw at itsindividual center point, then a universal aligning adaptor and abutmentare rotated on each other and the abutment/adaptor assembly is thenrotated in 5° increments until the abutment is ideally positioned withina maximal 2.5° deviation from the ideal direction.

One embodiment provides an assembly for restoring an edentulous sitewith a nonagon aligning, synchronizing implant fixture composed of aregular 9 sided polygon having 9 equal sides and 9 vertexes with 9 linesof symmetry each of which extend from a particular vertex 180° to anopposing side, wherein only one of the 9 vertexes had a symmetry linethat bisects its opposing side, and, therefore, serves as the index'sprimary indicium reference point for the ideal insertion of the implantsuch that a sagittal plane drawn at that reference point bisects theridge at a 90° angle when the implant is ideally situated with its axisof rotation and synchronization being in a preferred horizontal andvertical predetermined location in the bone and a set of prostheticcomponentry for restoring the implant that are synchronized to theimplant's primary indicium and to each other via their co-operableindicia are, therefore, also situated in a preferred horizontal andvertical predetermined location for creating the ideal restoration whentheir primary indicia overlay each other.

The nonagon implant can either have an internal or an external index.The co-operable indicia can include graduations for indicating thedegree of rotation of the prosthetic componentry relative to theimplant's primary indicium reference point. The co-operable indicia caninclude primary and secondary indicia such that the primary andsecondary indicia of the prosthetic componentry are rotatable inrelation to the primary indicium of the implant as they are rotated to adesired predetermined position. The primary indicium of the nonagonimplant determines the positioning of the prosthetic componentry intotheir preferred positions as they are rotated with their primary andsecondary indicia in a set position relative to the implant's primaryindicium.

The bisecting vertex can serve as a primary indicium. In one suchembodiment, the bisecting vertex has a different shape to distinguish itfrom the other vertexes.

In one embodiment, the nonagon implant and prosthetic components can beideally situated. An abutment, impression post, scanning post, healingcap, similar prosthetic component or prosthetic device for restoring theimplant to be received can be seated on the nonagon implant with itsprimary indicium overlaying the implant's primary indicium with thefinal prosthetic component, device or restoration being fabricated fromthat reference point, when the implant has been positioned in itspreferred, preplanned position.

When the nonagon implant has not been ideally situated and theprosthetic components correct for index misalignment, an aligningadaptor to be received and seated on the nonagon can be used to alignand synchronize an abutment in a predetermined position relative to theimplant's primary indicium. An abutment post or healing cap, prostheticdevice or similar prosthetic component for restoring the implant can bereceived on and rotated about the adaptor to reposition the prostheticcomponent in a generally desired vertical and horizontal predeterminedposition when the adaptor/prosthetic component assembly is seated on theimplant, wherein the adaptor and the prosthetic component haveco-operable indicia for identifying and registering the predeterminedposition of the prosthetic component.

The co-operable indicia include primary and secondary indicia such thatthe primary and secondary indicia of the prosthetic componentry arerotatable in relation to the primary indicium of the implant as they areturned into a desired predetermined position.

The polygonal structure at the top end of the adaptor can be an octagonstud and the bottom end of the adaptor that interfaces with the implantis a nonagon with the prosthetic component having an octagon orhexadecagon receptacle that engages the octagon stud of the adaptor. Themeans for adjusting the relative angular position of the adaptor to theprosthetic component followed by their assembly to the implant resultsin net 5° increments of horizontal rotation when the engaging receptacleof the prosthetic component is an octagon or results in net 2.5°increments of horizontal rotation when the engaging receptacle of theprosthetic component is a hexadecagon.

Methods of Aligning, Synchronizing, Referencing and Forming a Set ofUniversal Abutments and Prosthetic Devices

In the methods described, below, it is understood that the UniversalSystem rotates all abutments and other prosthetic components in 15°increments, or less, for the trichannel, quadragon, hexagon, octagon,and dodecagon implants. In these discussions, when a scan post is seatedfor an intraoral scan, it is assumed that an impression post can firstbe inserted followed by a bench scan.

Automated Technique Via Integrated Componentry in Combination with aSpecific Clinical and Digital Protocol:

The Universal System is a comprehensive system for restoring any type ofimplant restoration using either clinical prosthetic components orvirtual components in a software program, or both. It provides a methodof restoring an implant having any index configuration and/or alignmentby realigning, synchronizing, and referencing all restorative prostheticcomponents to set reference points. In certain embodiments, an automatedand interactive clinical and/or digital protocol can be used to realignand synchronize a physical or virtual implant prosthetic insert and aprosthetic component via their co-operable indicia. In this manner, theprosthetic component can be situated in a preferred, predeterminedposition, which ideally situates its subgingival and supergingivalconfigurations and provides the ideal position for the restoration.

One embodiment involves choosing the desired vertical angle correctingprosthetic component having the appropriate geometric shape forrestoring the implant. The prosthetic insert can be rotated about theabutment via their co-operable indices in relation to each other suchthat the prosthetic component is ideally situated over the implant. Theco-operable indices can then be identified and referenced at thatposition, which are the reference points for fabricating the finalprosthetic components and devices.

In a preferred, but by no means the only, embodiment, the cooperablecomponentry have graduated reference points and/or a mechanism ofprimary and secondary indicia that establish the rotation andsynchronization points, and the prosthetic insert is a universalaligning adaptor that has a specific primary reference indicium to whichall other cooperable componentry are synchronized. It is thesynchronization of all of the componentry that contributes to automatingthe restorative procedures with a dramatic reduction in operator error.

In addition, the system transforms the rotation of abutments from beingaround the central axis of the implant to a redefined central axis ofrotation that has been developed using a series of predefined points ofrotation with the result being that all interim and final abutments andhealing caps are ideally situated after being rotated in 15° incrementsor less. As such, this is accomplished by rotating the universalaligning adaptor in a clockwise or counter clockwise direction about anabutment or healing cap, wherein its primary indicium is positionedunder a predetermined primary or secondary indicium of the prostheticcomponent to achieve the desired rotation.

The rotation by primary and secondary indicia of the co-operable adaptorand its overlying prosthetic component is facilitated by dissimilarpolygonal structures at the free end and open end of the adaptor suchthat the rotation of the adaptor and prosthetic component results inincrements of horizontal rotational adjustment over the implant.

In certain embodiments, the polygonal structure at the open end of theadaptor is an octagon stud and the free end of said adaptor is ahexagon, tripod, dodecagon or other configuration wherein the number ofpolygonal sides is a multiple of 3 and said prosthetic component has anoctagon or hexadecagon receptacle that engages the octagon stud of theadaptor. This configuration allows for adjustment of the relativeangular position of the adaptor to the prosthetic component followed bytheir assembly to the implant results in net 15° increments ofhorizontal rotation when the engaging receptacle of said prostheticcomponent is an octagon. One can achieve net 7.5° increments ofhorizontal rotation when the engaging receptacle of said prostheticcomponent is a hexadecagon. When the polygonal structure at the open endof said adaptor is a hexagon stud and the free end of said adaptor is anoctagon or other configuration wherein the number of polygonal sides isa multiple of 8 and the prosthetic component has an hexagon or dodecagonreceptacle that engages the hexagon stud of the adaptor such that themeans for adjusting the relative angular position of the adaptor to saidprosthetic component followed by their assembly to the implant alsoresults in net 15° increments of horizontal rotation when the engagingreceptacle of said prosthetic component is an octagon. One can achievenet 7.5° increments of horizontal rotation when the engaging receptacleof said prosthetic component is a dodecagon.

When the polygonal structure at the open end of said adaptor is anonagon stud and the free end of the adaptor is a quadragon and theprosthetic component has an nonagon receptacle that engages the nonagonstud of the adaptor such that the adjustment of the relative angularposition of the adaptor to the prosthetic component followed by therotation of their assembly to the implant results in net 10° incrementsof horizontal rotation. Finally, the ideal adaptor/implant rotationoccurs in 5° increments of rotation, when the open end of the adaptor isan octagon and the free end is a nonagon that engages the unique nonagonimplant index.

These finite increments of rotation in stark contrast to the coarseincrements of rotation provided by the indexes of the implants such thatthe contour abutments, healing caps and prosthetic devices are ideallysituated, or even “centered” in the sagittal plane, allows the operatorto restore implants with asymmetric healing caps and abutments whichfosters a more natural emergence profile. As a result of those finiteincrements of rotation, the securing device of the multifunctionabutment aligns the screw access hole as close as possible to the centerof the occlusal table of the replacement tooth overlaying the implant.

The Universal System, as such, allows the restoration of any implanttype, regardless of its index misalignment with any implant restoration,whether they are well customized with milled, pressed, or cast abutmentsor are more simplistic with preformed, unprepared abutments that allow a“plug and play” operative routine.

In short, the prosthetic components are of a plurality of devicesincluding but not limited to healing caps, referencing abutment postsand healing caps, indexed healing caps, abutment posts, temporaryabutment posts, milled abutment posts, cast abutment posts, pressedabutment posts, zirconia abutment posts, impression posts, scanningposts, implant crowns, bridges, dentures, over dentures, screw downcrowns, hybrid dentures, and other prostheses for restoring dentalimplants. They can have asymmetrical or symmetrical contours at theirbases.

As stated, the prosthetic components and devices can be fabricatedclinically using physical devices and methods or can be constructed in asoftware program to create milled, stereolithograph generated, or othercomputer generated components.

Method of Fabricating a Set of Anatomic Abutments for Crown and BridgeRestorations for Implant Restoration:

A method of fabricating anatomic abutments by inserting an adaptor on adental implant in a predetermined position relative to the implant isalso disclosed. A preformed abutment having an asymmetric configurationcan be seated on the adaptor's open end. The open end is configured to,in turn, receive a crown, bridge, set of crowns or other similarprosthesis. The crown, bridge, set of crowns or similar prosthesis canbe first rotated about the adaptor followed by the adaptor/abutmentassembly around the implant until the abutment is in a generally desiredvertical and horizontal predetermined position when the adaptor isseated on the implant. This realigns the abutment such that itsasymmetric configuration is properly situated to reestablish ideal form,function and esthetics even when the implant index is misaligned andsets them off angle, wherein the adaptor and abutment have co-operableindices for identifying and registering the predetermined position ofthe abutment. The co-operable indicia also permits the adaptor andabutment to be rotated relative to each other into the predeterminedposition of the abutment while the adaptor is detached from the implant.The abutment has now been set to a specific position in relation to theprimary reference indicium of the adaptor. From this point on, theprimary reference indicium of the adaptor dictates the restoration ofthe final abutment and overlying prosthetic device.

With this in mind, primary indicium of the adaptor then determines theseating of an impression post, an intraoral or bench scanning post, or aCBCT scan post also having co-operable indices such that they referencethe abutment's predetermined, preferred position for fabricating thefinal abutment and/or the prosthesis that is seated on it.

The abutment is of a plurality of devices including but not limited totemporary abutment posts, final preformed abutment posts, castableabutment posts, pressable posts, or milled abutment posts, or otherposts fabricated by another suitable means that receive implant crowns,set of crowns, bridges, and other prostheses for restoring dentalimplants that are either cemented or screw retained.

There are many ways to fabricate crown and bridge restorations that areseated over implants, some of which are specifically described hereinfor exemplification purposes, but are not intended to be inclusive ofall abutments: the preformed, unprepared crown and bridge abutment thatis intended to be used for the simplest technique; the preformed,customizable abutment pattern that is intended to be rotated and alignedand then customized prior to being converted to a cast or pressedceramic abutment via a burnout of the pattern in the “lost wax”technique. The castable or pressable abutments can be fabricated to bereceived on an adaptor or can be “cast-to” or “pressed-to” an adaptor ofa complimentary material, and can, therefore, be created such that itengages the index of the implant without any interfacing adaptor. TheUniversal System's versatility allows the creation of either type ofimplant connection-with or without a titanium connector, depending uponthe preference of the operator.

When choosing the abutment, the operator can also elect to have astandard symmetrical base for the abutment or can choose a more custom,preformed asymmetrical configuration to support the gingiva with anemergence profile that is similar to a natural tooth in that implantfixture's position, after it has been rotated to ideally situate thatgingival contour. When contours are already incorporated in the interimabutments or healing caps, and impression, scanning, or imaging posts orother prosthetic devices that share the same preformed symmetrical orasymmetrical configuration as the base of the abutment, the processbecomes automated while being customized, as well. Even if theimpression or scan is taken of the adaptor (without an indexed base orhealing cap), the preferred gingival contour base or healing cap can be“dialed-in” to the virtual abutment to establish the preferred emergenceprofile. When the abutment is inserted, the tissue can be scalloped toaccommodate it.

Because of the unique centering of the abutment's primary indicium suchthat the component is ideally situated, the Universal Contour Abutmentcan consistently have all of its abutments with internal lingual threadsto receive screw retained crowns. The internal thread for the crownfixation screw is placed in the esthetic zone, which is predictably 180°from the buccal aspect of the abutment. Practitioners have been seekinga retrievable crown as an alternative to permanently cemented crownsover implants.

The Preformed, Unprepared Contour Abutment for Simplified, StandardImplant Restoration

A method for restoring a dental implant wherein the operator is seekinga simplified, basic technique using standardized componentry and asingle process. An adaptor is seated on a dental implant in apredetermined position relative to the implant, which, in turn, receivesa preformed, unprepared abutment having an asymmetric configuration uponwhich an interim coping and a referencing coping are seated. All of themhave cooperable indices for aligning, synchronizing, and referencing theinterim abutment to create the final abutment. This method can comprisethe steps of rotating the adaptor and abutment relative to each othersuch that the abutment is in a predetermined, preferred position that isnoted. An interim preformed coping composed of acrylic or anothersuitable temporary restorative material for molding a temporary crown toit can be aligned and seated such that it is automatically in thepreferred position. One can then remove the interim coping/temporarycrown assembly and seat a reference coping with the same alignment asthe interim coping to identify and register the position of the adaptorand the abutment. One can then fabricate a final abutment having thesame preferred horizontal and vertical position as the interim abutment.

The process begins with the seating of the acrylic coping on the ideallypositioned abutment such that its primary indicium is aligned with theprimary indicium of the abutment prior to relining a previouslyfabricated or molded temporary crown. In most instances, the temporarycrown has been prefabricated by the laboratory.

When ready to fabricate the final abutment and crown, the referencingimpression coping is seated on the abutment to identify and referenceits primary indicium that is aligned with the primary indicium of theabutment, along with registering the primary and secondary rotationpoints of the abutment in relation to the primary reference indicium ofthe adaptor that were previously noted. The impression coping is liftedin the impression and serves as a referencing and seating device for anabutment replica with the same geometry as the interim abutment with themodel being poured and the final abutment being cast, pressed, or milledor fabricated by some other type of method such that it has the samerelationship to the implant's index as the interim abutment or healingcap. Following the step, one can fabricate the overlying prosthesis.

In certain embodiments, the referencing coping is a scanning coping witha geometric configuration that is ideal for an intraoral or bench scanand/or CBCT scan to register the position and configuration of theinterim abutment to create a milled abutment.

The final abutment is either a replica of the interim abutment, or, ifthe operator so chooses, can be fabricated by one of the methodsoutlined above. The preformed abutment can have a symmetric orasymmetric base with a preferred geometry of appropriate configurationand depth to vertically position the base in relation to the gingivalarchitecture. In certain embodiments, the crown is fabricated to fit theinterim abutment, which, therein, becomes the final abutment.

The Universal Contour Screw Retained Crown

This method describes the predictable fabrication of screw retainedcrowns via a contour abutment seated an adaptor having co-operableindices wherein the abutment has the geometry of a natural toothpreparation and has internal screw threads that are positioned in theesthetic zone approximately 180° from the primary indicium of theabutment after it has first been ideally situated such that a crown, setof crowns, or bridge are receivable on the abutment and are retained bythe fixation screws that engage the abutment fixation screw threads. Incertain embodiments, the method involves rotating an abutment to apreferred horizontal and vertical position. From this position, one cancreate the screw threads by milling them, setting internally threadedtubes, die tapping, or by another appropriate method at that locationsuch that the threads are ideally positioned in the esthetic zone and atthe most ideal pitch for receiving a driver that is carrying the screw.The proper esthetic zone and ideal pitch would be known for the dentalsurgeon. One can then create the overlying prosthetic component with astop for securing the prosthetic component on the abutment and affix itwith a fixation screw that engages the internal threads.

In certain embodiments, the method makes use of co-operable indicia thatincludes primary and secondary indicia such that the primary indicium ofsaid adaptor is rotatable in relation to the secondary indicium of theabutment as defined by the desired predetermined position and thelocation of the abutment's primary indicium determines the location ofthe fixation screw threads.

In certain embodiments, the adaptor is rotated around the abutment andthe assembly is rotated over the implant such that the primary indiciumof the adaptor is aligned with a specific primary or secondary indiciumof the abutment when it reestablishes the preplanned, preferred positionof the multifunction abutment to compensate for implant indexmisalignment, and the screw thread is positioned approximately 180° fromthe primary indicium.

The Universal Contour Healing Cap

This method discloses the creation of preferred gingival architectureover an implant using a contoured healing cap that is seated on anadaptor, with the adaptor/healing cap assembly being seated on a dentalimplant in a predetermined position. The preformed, contoured healingcap has a specific symmetric or asymmetric configuration that issuitable for protecting the adaptor and maintaining a desired gingivalopening over an implant. It is receivable on and rotatable about saidadaptor, wherein the adaptor and the healing cap have co-operableindices to position said healing cap in a generally desired horizontalpredetermined position when said adaptor is seated on the implant withthe healing cap's primary indicium situated such that a replacementabutment also has its primary indicium in an ideal position with saidadaptor and healing cap whose co-operable indices permit said adaptorand healing cap to be rotated relative to each other into thepredetermined position of said healing cap while said adaptor isdetached from the implant.

The healing cap is of a plurality of devices including gingivo-adaptorswhich are healing caps and adaptors that are combined into one-pieceassemblies for connection to the implant, wherein the open end of thedevices have the preferred configuration and/or index of the chosenadaptors and the free end has the configuration and/or index of theparticular implants. The healing cap is composed from a plurality ofmaterials including titanium, titanium alloy, zirconia, or othersuitable materials and can be coated by anodizing or some other method.

The primary indicia of the healing cap determines the positioning of theabutment post when it is to be rotated such that its primary indiciumand that of the healing cap are in the same preferred position.

The contour healing cap can have a gingival geometry that is appropriatefor that implant at that site for that type of tooth abutment that wouldbe located there, because of the realignment that occurs independentlyof the implant's index.

Tissue Engineering from A to Z

Also provided is a method of tissue engineering over a dental implantwherein a particular gingival architecture is developed using an adaptorin combination with an interim healing cap, abutment, or other interimcomponent having co-operable indices for repositioning theadaptor/interim prosthetic component assembly to a predetermined,preferred position wherein its gingival contours are used as a templateby the surgeon to shape the tissue over the implant. In certainembodiments, it is possible to open the tissue over the implant androtate an adaptor and a chosen interim component relative to each otherand the assembly relative to the implant via their co-operable indicessuch that the desired gingival contours are ideally situated over theimplant to most naturally support the tissue with the proper emergenceprofile. Gingival tissue can then be sculpted as the adaptor/interimprosthetic component assembly is seated. In this manner it is possibleto mold the tissue to the architecture of the interim component, ratherthan molding the abutment to match the tissue with inconsistent results.The interim component can be removed from the adaptor and an impressionor scanning post or other registering device can be seated in relationto the primary indicium of the adaptor. Once seated, it is possible toregister and identify the ideal position and type of final abutment orprosthesis to be inserted over the implant. A final abutment can then befabricated such that it mimics the subgingival contours of the interimabutment and integrated with the image of the surface topography. Incertain embodiments, the adaptor and the interim abutment can be removedand replaced with a final abutment which has co-operable indices forprecisely positioning its gingival contours with the same relationshipas the interim component.

The co-operable indices can include a mechanism of primary and secondaryindicia such that the primary indicium of said adaptor is rotatable inrelation to the secondary indicium of the abutment as defined by thedesired predetermined position. The rotation of the adaptor to theprosthetic component followed by their assembly to the implant resultsin net 15° increments of horizontal rotation when the open end of theadaptor is an octagon and the free end that engages the implant is atripod, hexagon, or dodecagon or the open end of the adaptor is ahexagon and the free end that engages the implant is an octagon. Inaddition, the rotation of the adaptor to the prosthetic componentfollowed by their assembly to the implant results in net 10° incrementsof horizontal rotation when the open end of the adaptor is a nonagon andthe free end that engages the implant is a quadragon.

The interim healing caps and abutments have a plurality of preferredgingival contours and serve as surgical and design templates for thetissue training around the interim abutment and the fabrication of thefinal abutments when they are in their preferred positions. The finalabutments can be cast, pressed, milled, or preformed, and can befabricated such that they either interface with an adaptor to theimplant or interface directly with the implant without an adaptor.

In certain embodiments, the tissue architecture is first analyzed in aCT scan wherein the prosthesis is also scanned to capture the tissuearchitecture, prior to the surgery as a part of choosing the preferredinterim healing cap, abutment or other prosthetic component. In certainembodiments, a virtual adaptor can be chosen and the preferred virtualprosthetic component, having co-operable indices, can be rotated overthe virtual adaptor in a CT scan program to a predefined position asdelineated by the primary indicia of the adaptor in relation to theprimary and secondary indicia of the prosthetic component. In therotated position, one can measure the depth from the bone to thelocation where the virtual prosthetic component exits the gingiva atpredetermined points on the healing cap. The preferred clinicalprosthetic component to be used during the surgery according to thedesired gingival architecture and its depth can then be selected and,when applicable, the vertical angle correction also made.

The initial tissue opening can be precisely created by a universalguided tissue punch comprising the steps of locating the open end of theimplant and removing the cover screw, inserting a surgical guiding screwwith an extra-long shank and threading it into the implant's internalthread, followed by the rotation of a universal guided tissue punchhaving an internal polyhedron to receive the guiding screw and havingthe exact outside diameter as the implant such that the guiding screwprecisely guides the tissue punch as it excises the tissue over theimplant. In certain embodiments, a guiding polyhedron is inserted intothe index of the cover screw of the implant with the guided tissuepunch, having a matching internal configuration, being rotated over theimplant until the tissue is excised, as described above. The universalguided tissue punch can also demarcate when the tissue should not beexcised because of implant angle in relation to the attached gingivaltissue, but, rather, should be repositioned to prevent its loss over theimplant.

The universal guided tissue punch can be used with any implant at anyangle and can be used to excise the tissue removal as directed by anypolyhedron seated on the implant or its cover screw that is in line withits long axis.

Finally, the repositioned prosthetic component can be registered viaimpression or scan of the adaptor or overlying indexed healing cap suchthat its gingival architecture in its preferred position is translatedto the final abutment and/or prosthesis, which is then inserted over theimplant with the same gingival contour in the same position.

The Indexed Healing Cap for a Simplified Impression or Scan

One embodiment provides a method of restoring dental implants by usingindexed healing caps or similar tissue supporting interim devices thatare also referencing devices which have co-operable indices foridentifying and referencing adaptor and abutment positions withouthaving to be removed from the implant. This can, thereby, simplify thefabrication of abutments and/or prosthetic devices for restoring dentalimplants. In certain embodiments, the healing caps can be rotated overtheir adaptors and the adaptor/healing cap assemblies over theirimplants according to an automated and interactive clinical and/ordigital protocol such that they are situated in preferred vertical andhorizontal predetermined positions over their implants. Once rotated,the referencing posts such as impression posts, the scanning posts, orimaging posts can be inserted on each healing cap such that the primaryindicium of the referencing post is aligned in relation to the primaryindicium on the healing cap's index with an impression, intraoral orbench scan, or a CBCT scan being taken of the healing cap/referencingpost assembly such that it registers the adaptor's position in relationto the implant index, the indexed healing cap's position in relation tothe adaptor, the referencing post in relation to the indexed healing capalong with the other anatomic structures in the jaw. It is then possibleto fabricate cast, pressed, milled, or other abutments to thosepreferred positions, followed by the fabrication of the implantprostheses.

The co-operable indices include graduated reference points and/or amechanism of primary and secondary indicia such that the primaryindicium of the adaptor is rotatable in relation to the primary andsecondary indicia of the indexed healing cap as defined by the desiredpredetermined position of the healing cap.

The automated and interactive clinical and/or digital protocol caninclude choosing the appropriate indexed healing cap or similarprosthetic component having the desired geometric shape for the tissueover the implant, rotating it as necessary in either a predeterminedclockwise or counterclockwise direction such that the primary indiciumof the adaptor is positioned at a particular primary or secondaryindicium point of the healing cap, and is, in turn, set in relation tothe index of the implant such that its gingival contours are ideallysituated in a preferred, predetermined position over the implant. Theindexed healing cap can also be used as a template for sculpting thegingiva.

The primary indicium of the healing cap is located at the center pointof the healing cap as it bisects the ridge at a 90° angle in thesagittal plane or another preferred position, which, therein, identifiesthe location for seating the impression or scanning post. In certainembodiments, the primary indicium of the impression post, scanning post,or imaging post overlay the primary indicium of the healing cap. Theindex of the healing cap can have a polyhedron adjacent to the primaryindicium of the healing cap such that the polygon of the polyhedron isbisected at that point. The primary indicium on the polygon of thehealing cap receives the impression or scanning post such that theprimary indicia overlay each other and, thereby, capture the primaryindicium at its center point. The polygon can be an index that is anexact replica of abutment engaging index on the open end of the adaptor.

The Method of Using the Universal Multifunction Abutment to RealignScrew Access Holes:

The multifunction abutments can be used for restoring any screw borneprosthesis such that its screw access holes are realigned into preferredpositions is disclosed. The multifunction abutments are seated on androtatable about universal aligning adaptors followed by theadaptor/abutment assemblies around the implants until said abutments'screw access holes are realigned to generally desired vertical andhorizontal predetermined positions, which approximate the center of theocclusal tables of the tooth replicas for those implants being restoredwith the screw borne prosthesis. Said adaptors and said abutments haveco-operable indices for identifying and registering the predeterminedposition of said abutments, after permitting the adaptors and theabutments to be rotated relative to each other such that the abutmentsare in ideal positions.

Said co-operable indices include graduations for indicating the degreeof rotation of said abutment and said adaptor relative to each other,which can include primary and secondary indicia, wherein the primaryindicium of said adaptor is rotatable in relation to the primary orsecondary indicium of the multifunction abutment as it is rotated to itsdesired predetermined position such that its primary indicium is ideallysituated.

The multifunction abutment has a polyhedron that is shaped to receiveanother polyhedron over it, which has a matching engaging configurationthat engages it, and is, in turn, connected to the prosthetic device viaa chemically cured, light cured, or other combination method to createthe screw retained prosthesis. In a preferred embodiment the abutmentpolyhedron is a cone with an asymmetrical flat at its primary indiciumwhich is located approximately 180° from the midpoint of the verticalangle correction of the abutment and the engaging polyhedron is inside aconnecting cylinder. The flat provides a positive seat at its primaryindicium and prevents rotation of the connecting cylinder during theassembly phase along with preventing natural rotational forcesassociated with a cylinder on a cone from dislodging it.

The primary indicia of the cone on the multifunction abutment determinesthe seating of an impression post, an intraoral or bench scanning post,or CBCT scan post also having co-operable indices such that theyreference the realignment of the abutment at its predetermined,preferred position that ideally situates the screw access hole whenfabricating the final abutment and/or the prosthesis that is seated onit.

The multifunction abutment is of a plurality of devices including butnot limited to preformed temporary abutment posts, preformed finalabutment posts, castable posts, pressable abutment posts, or milledabutment posts, or other posts fabricated by another suitable meanswherein they receive the prosthesis that is screw retained to them whenrestoring the implants.

The prosthesis that is seated on the multifunction abutment is of aplurality of devices including but not limited to an overdenture bar forreceiving a snap on denture, a snap on denture that is connected toretaining devices seated directly on the adaptors or implant abutmentsseated on adaptors without a connecting bar, a transitional hybridprosthesis that has been converted from a denture to a fixed, screwretained prosthesis during the insertion of a set of implants during animmediate load procedure, a screw retained denture or similar prosthesiswith flanges, a screw retained crown, set of crowns or bridge with orwithout flanges.

The multifunction abutment can be milled out of any suitable restorativematerial and is fabricated by first rotating a virtual multifunctionabutment into a preferred position over a virtual adaptor using theuniversal aligning system's automated and interactive clinical protocolin a milling software program to define the synchronized axis ofrotation and, thereby, eliminate the mesial-distal abutment misalignmentprior to milling it, followed by milling the abutment according to theparameters established by the rotation such that either a single piece,final abutment for insertion on the implant which engages its indexwithout an interfacing adaptor or a final abutment to be receivable onthe adaptor with the assembly then being inserted on the implant ismilled with the prosthetic device then being milled and affixed to it.

The Universal Multifunction Abutment System's Use in SimplifyingProcedures for the Immediate Load Transitional Hybrid Prosthesis:

A method of immediately restoring dental implants at the time of theirinsertion with an immediate load transitional screw retained prosthesisby first using a set of aligning multifunction abutments and universaladaptors having co-operable indices wherein they are rotated andsituated in finite increments such that the screw access holes of theabutments receiving the prosthesis are ideally located regardless of thetype of implant indexes or their misalignment, the steps comprising therotation of the adaptor and the abutment having the co-operable indicesaround each other, followed by the assembly around the implant accordingto an automatic and interactive clinical protocol with the abutment nowbeing in a preferred vertical and horizontal predetermined position whenit is seated on the previously inserted implant such that the screwaccess hole is as close to the center of the occlusal table of thereplacement tooth as possible, trying in the denture or other prosthesisover the abutments and adjusting the holes where they seat over theabutments, placing a connecting cylinder over each abutment until itengages its receiving polyhedron, affixing it to the abutment,connecting the cylinders to the denture therein creating thetransitional screw retained prosthesis, and removing, finishing, andreinserting the transitional screw retained prosthesis.

In certain embodiments, in order to provide additional strength to theappliance, a bonding sleeve that adheres to acrylic or other restorativematerial used in the conversion of the denture is seated over thecylinder with an adhesive and is connected to the denture with anappropriate acrylic or composite to create a one-piece screw retainedtransitional prosthesis.

The co-operable indices includes a mechanism of primary and secondaryindicia such that the primary indicium of said adaptor is rotatable inrelation to the primary and secondary indicia of the prostheticcomponent as defined by its desired predetermined position.

The automated and interactive clinical and/or digital protocol includeschoosing the appropriate multifunction vertical angle correctingabutment or equivalent prosthetic component having the desired geometricshape for that type of restoration over the implant, rotating it asnecessary in either a predetermined clockwise or counterclockwisedirection such that the primary indicium of the adaptor is positioned ata particular primary or secondary indicium point of the abutment and isset in relation to the index of the implant when the multifunctionabutment is being positioned in a preferred, predetermined horizontaland vertical location over the implant such that the screw access holesapproximate the center of the occlusal tables of the replacement teeth.In certain embodiments, the primary indicium of the multifunctionabutment is centered in the sagittal plane as it bisects the ridge whenit is at a 90° angle to the ridge and the abutment is in its idealposition.

This preferred location is created when the adaptor is rotated aroundthe abutment and the assembly is rotated over the implant such that theprimary indicium of the adaptor is aligned with a specific primary orsecondary indicium of the abutment when it reestablishes the preplanned,preferred position of the multifunction abutment to compensate forimplant index misalignment.

In certain embodiments, the restorative dentist can seat the abutmentsand adaptors on the implants according to their position in CT scangenerated or other model, can then reassess their positions, and thenrotates them with rotatable, universal aligning analogs until they areideally situated in the CT scan generated or other model. He then seatsthe denture over the abutments on the model and prepares it to receivethem, and then removes them from their analogs and seats them on theirimplants in the same positions, using those rotation points as a guide.

In certain embodiments, antirotational cylinders having an internal flatthat matches to the configuration of the cone or other projection on themultifunction abutment are placed over these projections which have amatching flat at their primary indicium such that the primary indiciumof the cylinder overlays the primary indicium of the cone. Thisconnection provides a positive seat during manipulation and affordsresistance to dislodgement.

In certain embodiments, a bonding sleeve that adheres to acrylic orother restorative material used in the conversion of the denture isseated over the cylinder with an adhesive and is connected to thedenture with an appropriate acrylic or composite to create a one-piecescrew retained transitional prosthesis.

To register the multifunction abutments, the transitional appliance isremoved from the abutments and impression posts or scanning posts areinserted over the multifunction abutment posts such that their primaryindicia are aligned, and, either an impression or an intraoral, bench,or CBCT scan is taken to identify and register the location of theabutments' primary indicia in relation to the adaptors' primary indicia.Either an analog is placed in the impression such that its primaryindicium is positioned at the same reference points as established bythe adaptor's primary indicium with the bench scan then being taken, orthe data is directly conveyed to the scan code of a milling softwareprogram which directs the rotation of chosen virtual abutments prior tomilling the final prosthesis, which is seated on the abutments or onreplacement milled ones that are also being fabricated.

In certain embodiments, a Steriolithograph or other CT scan softwaregenerated model receives a removable, rotatable universal aligninganalog that is used to rotate an overlaying abutment or other prostheticcomponent to a preferred position to ideally situate the abutment'sscrew access hole.

A Method of Taking an Intraoral or Bench Scan and/or a CBCT Scan UsingUniversal Scan Posts and the Universal Automated Protocol forFabricating Milled Abutments

An intraoral or bench scan and/or a CT scan can be taken after implantshave been inserted and are ready for restoration with final abutmentsand prosthetic devices created by milling or another computer generatedprocess, as directed by an automated and/or interactive clinical and/ordigital protocol. The scan posts for the intraoral or bench scan and/orthe CT scan have readily identifiable primary reference points that areset in relation to the adaptor's primary reference indicium, and,therefore, to the implant index's alignment in the jaw. First, any oneof a number of universal aligning, synchronizing, and referencingdevices is repositioned over each implant into a preferred,predetermined position. The referencing device can be composed of ahealing cap, interim abutment, or other prosthetic component seated onan adaptor, both of which have co-operable indices for directing theirrotation and, thereafter, serve as reference points for identifying andregistering the new prosthetic component position, wherein the automatedand/or interactive clinical and/or digital protocol is used to ideallyposition the prosthetic component of each device over its implant and tothen synchronize all other components to those repositioned referencepoints. The adaptor is rotated about the prosthetic component, followedby the adaptor/prosthetic component assembly around the implant suchthat the prosthetic component is now in a preferred, predeterminedvertical and horizontal predetermined position when it is seated on thepreviously inserted implant. The prosthetic component is removed fromthe adaptor, the location of the reference points in relation to eachother as well as to the implant's index is identified, along with thedesired vertical angle correction for each implant. A scanning post isseated on the adaptor such that its co-operable indices and those of theadaptor are aligned in some manner, and an intraoral or CT scan is takento identify and reference the relative positions of the adaptors and theimaging posts to their implants' indexes along with their anatomicalgingival architecture around each implant and the geometry of the jaw orjaw segment. In certain embodiments, an impression post is seated at thesame location on the implants and an impression is taken, a model ispoured, and a bench scan is taken to achieve the results.

The data is then translated, including the relational positions of theco-operable indices and other aspects of the universal aligning scancode to the milling device codes and controls of a software program formilling prosthetic components after importing the CT scan images. Avirtual automated rotation or a virtual manual rotation of eachpreferred abutment is then performed over its virtual universal aligningadaptor for each implant site such that its co-operable indices arelocated in the clinically desired positions for the prosthetic componentand the adaptor of the referencing device, such that the prostheticcomponent is ideally situated on the monitor, milling the abutment foreach site according to the parameters of the virtually rotated abutment,milling the copings or framework that will be receiving any veneeringmaterial, inserting the milled abutments on their respective implantsand inserting the milled copings or framework over the abutments, takinga bite relationship as needed, and fabricating the final prosthesis. Incertain embodiments, the prosthetic device can be designed over therotated virtual abutment and then milled to fit on the previously seatedabutment without also milling the abutment.

In a preferred, but by no means only, embodiment, the co-operablereferencing devices and other componentry have graduated referencepoints and/or a mechanism of primary and secondary indicia thatestablish the rotation and synchronization points, and the virtualabutment is composed of a virtual universal aligning adaptor that has aspecific primary indicium to which all other cooperable componentry aresynchronized. It is the synchronization of all of the componentry thatcontributes to automating the restorative procedures with a dramaticreduction in operator error.

The prosthetic component of the referencing device can be rotated ineither a predetermined clockwise or counterclockwise direction over anadaptor such that its primary indicium is ideally situated, while theprimary indicium of said adaptor is positioned at a particular primaryor secondary indicium of said prosthetic component, with the primaryindicia of both components now being situated in relation to the indexof the implant for that rotation. The scanning posts are synchronized tothe primary reference indicium of the adaptor, and, thereby register thecentral axis of rotation that establishes the preferred, predeterminedposition of an abutment on the implant.

In another embodiment associated with the above techniques, an indexedhealing cap of any configuration having primary and secondary indiciacan first be rotated such that its primary indicium is centered in thesagittal plane as it bisects the ridge when it is at a 90° angle toridge, wherein any abutment that would be exchanged for the healing capin that position would also be ideally situated. The impression post(for the bench scan) or the scan post (for the intraoral or CBCT scan)is merely seated on the index with their primary indicia overlaying.

The automated and/or interactive digital protocol includes choosing theappropriate physical or virtual vertical angle correcting abutment,healing cap, or other prosthetic component having the desired geometricshape for that type of restoration over the implant from a library,rotating it as necessary in either a predetermined clockwise orcounterclockwise direction such that the primary indicium of the adaptoris positioned at a particular primary or secondary indicium point of theabutment whose primary indicium has been ideally situated, and is,therein, set in relation to the index of the implant.

Once the scan process is completed with the data having been translatedto the software program by inputting the primary or secondary rotationpoint that is overlaying the primary indicium of the adaptor, thevirtual abutment is auto-rotated when the abutment is in its preferredposition such that its primary indicium is in the established positionof the clinically rotated and inserted abutment. The practitioner canalso interactively manipulate the virtual abutment into a more preferredposition.

In certain embodiments, the practitioner can elect to by-pass theinsertion of the multifunction abutment prior to fabricating the milledprosthesis. He first rotates the interim abutments or healing caps intotheir preferred positions and makes note of the locations of theadaptors' primary reference indicia. The interim abutments or healingcaps are removed with the appropriate impression and/or scanning postsbeing seated in relation to the adaptors' primary reference indicia. Thesteps outlined above are then followed in preparation for the milling ofthe prosthesis and/or abutments. The design of the scan posts, alongwith the universal automated and/or interactive clinical and/or digitalprotocol provides a high degree of accuracy. To the extent that animpression can be avoided with the intraoral or CBCT scan. Combining theintraoral or bench scan with the CBCT scan further assures accurateresults, since the CBCT scan data is absolute.

The contour or multifunction abutments are then milled according to themilling device codes of the particular milling program. The overlayingprosthetic devices are then milled to fit the abutments. In certainembodiments, the prosthetic devices are milled such that they directlyengage either the adaptor index or the implant index without anyinterfacing abutment.

In those situations when automated tissue engineering has beeninstituted and established, wherein the gingival architecture of thehealing cap is to be replicated, data for that particular base memberand the topography of the overlying tissue are combined to create thecharacteristics of the developed gingival architecture, which are thenincorporated into the data set.

The abutments are milled according to the program's milling device codesand controls either to fit on an implant with an interfacing adaptor orto be milled directly to the implant index, such that they are ideallypositioned, regardless of the configuration of the implant index or itsalignment. The final abutment are being milled with the appropriate formfor that abutment type, implant site, implant angulation, gingivalarchitecture and any other pertinent characteristics being applied tothe milling.

Subsequently, the copings or the framework of the prosthesis that is tobe seated on the milled abutments is milled to fit on the previouslymilled abutments, or on already seated preformed abutments.

In certain embodiments, a stereolithograph or other CT scan softwaregenerated model is fabricated which reproduces the adaptors' primaryreference indicia in their exact positions to receive the milledabutments, and, if applicable, the framework. In another embodiment, astereolithograph or other CT scan software generated model withreproductions of the milled abutments in their exact positions asestablished in the software program. In, yet, another embodiment, astereolithograph or other CT scan software program generates a modelthat has a receptacle that is created at each implant site in the modelto receive a universal aligning analog whose shank configuration has thesame polygonal configuration as the free end of the adaptor that engagesthe index of the implant being restored and whose open end has theappropriate index to engage the abutment that is seated on it with theanalog being removable and rotatable such that, when rotated with theabutment, the analog allows for a horizontal angle correction of theabutment in 15° increments, or less. This allows the technician theflexibility of further customizing the abutment and prosthesis.

Merging the Intraoral or Bench Scan with the CBCT Scan Using theUniversal Scan Posts and the Universal Automated and/or InteractiveClinical and/or Digital Protocol for Implant Restoration:

An Intraoral and/or bench scan and a CBCT scan are taken using scanposts having co-operable indices as well as a common geometricconfigurations such that they can be synchronized to each other via acommon reference indicium, which has either been set in relation to thealignment of the implant's index in the jaw, or, more specifically, hasbeen oriented in relation to a well-defined primary reference points orset of points of the Universal Aligning Adaptors. The intraoral/benchscan image is merged with the CBCT scan image as they are alignedaccording to the shared common reference indicia that are on theprosthetic component and the co-operable adaptor. Additional commonreference points may be used, as well, such as one or more polyhedronson the scan posts. In a preferred embodiment, a universal aligning,synchronizing and referencing device having a primary reference indiciumis first positioned over an implant in relation to the primary referenceindicium of the adaptor that has been rotated such that its prostheticcomponent is in a preferred position. The prosthetic component of thereferencing device can be an actual abutment. The prosthetic componentis removed and the appropriate scanning post for the intraoral or benchscan or the CT scan post for the CT scan having co-operable indices areseated with their primary indicia such that they are aligned in relationto the adaptor's primary reference indicium with the scan then beingtaken to identify and register the location of the adaptor's primaryreference indicium, which has been positioned in relation to the indexof the implant.

In certain embodiments, the scan posts have one or more polyhedrons ontheir external surfaces that serve as their primary referencing indicia.The polyhedrons provide an additional means for merging the intraoral orbench scan images with the CT scan image. The former images provide arelationship of the implant index via the scan post to the surroundinggingiva and adjacent teeth, whereas the CBCT image provides an absoluterelationship of the scan post, and, therefore, the implant index to thehard structures of the jaw (the implant, the bone and the teeth). Thisrelationship of the implant index (via the primary referencing indiciumof the adaptor) is absolute and provides a set of reference points formerging the soft tissues around and over the implant to the absoluteposition in the sagittal, axial, and coronal planes of the implant, aswell. The Universal System allows the fabrication of final abutmentsand/or prosthetic devices from intraoral, bench, or CBCT scan toregister the implant position, because it transforms the central axis ofthe implant to a preferred central axis of rotation via predeterminedreference points so that the virtual abutment rotated into a preferredposition. However, the process becomes even more precise when theintraoral or bench scan is merged with the CBCT scan, which, once again,establishes the absolute position. Furthermore, if the images are takenwith the data of the configuration of the bases having preferredgingival architecture, the fabrication of the abutment with customgingival contours becomes automated. To the extent that the therapists(surgeon, restorative dentist, and technician) pool their efforts bymatching the final contour base to the original healing cap or interimabutment base, the process becomes further automated with greaterprecision and a dramatically reduced margin of error. If the scan postsare seated on indexed healing caps, the registration is even morestreamlined.

In certain embodiments, the polyhedrons can be arranged in an X-Y-Zplane to facilitate their imaging and subsequent merging, since themerging of the images is accomplished by aligning three differentimages. In a preferred embodiment, these polyhedrons on the scan posts(and, therefore, in the images) are dissimilar and, therefore, mosteasily picked up by the scanner. In fact, with the appropriateprogramming, the intraoral or bench scanner does not even have to imagethe complete post, but, rather, once it has located the polyhedrons, itwill fill in the images, since it has the configurations of the scanposts input into the library within the universal scan code.

The base member's geometry can also be used as a reference plane tomerge the intraoral/bench scan and CBCT scan images. The base memberscan be an indexed healing caps that have previously been repositioned inpreferred, predetermined vertical and horizontal positions, wherein thescanning posts are individually inserted over the indexes of the healingcaps such that the primary indicia of the scanning posts are aligned inrelation to the primary indicia on the healing caps' indexes with anintraoral or bench scan and a CBCT scan then being taken of the healingcap/scanning post assemblies such that it registers the adaptors'positions in relation to the implant indexes, the indexed healing caps'positions in relation to their adaptors, the scanning posts in relationto the indexed healing caps, along with the other anatomic structures inthe jaw, in relation to the preformed gingival architecture of thehealing caps.

To summarize, a preferred technique employing tissue engineering, thesurgeon rotates the adaptor around the chosen healing cap and theassembly around the implant and notes the location of the adaptor'sreference indicium. He sculpts the tissue as he seats the assembly sothat the tissue matures and forms to its geometry, The restorativedentist either takes an impression and the laboratory performs a benchscan, or he takes an intraoral scan an adaptor, indexed healing cap, orabutment, either procedure of which captures the developed soft tissuein relation to the underlying implant in its existing alignment (via theadaptor referencing indicium location). In a preferred embodiment, anindexed healing cap is used to receive the impression or scan post. Ifmore than one scan has been taken, the images can be merged using theuniversal scan posts reference points to merge the images. Thetechnician then performs an autorotation in a milling software programas dictated by the location of the adaptor reference indicium for thatimplant with its specific index, and, then, “inserts” the healing capthat is a replica of the one that is seated on the implant. The contourabutment or the multifunction abutment is then milled. The contourabutment is milled with the ideal tooth preparation form, anglecorrection, and gingival architecture, or the multifunction abutment ismilled with the screw access hole relocated to its ideal position andthe coping, set of copings, or framework are milled to fit either theexisting multifunction abutments that are seated on the implants or onthe newly milled abutments.

The Use of a Virtual Referencing Device in a Milling Software Programfor Fabricating Milled Abutments and Prosthetic Devices:

The Universal System is a comprehensive system for fabricating milledabutments, other prosthetic components or devices, or dental prosthesesby means of a virtualized aligning, synchronizing and referencing deviceoperable in any milling software program, consisting of a virtualadaptor and an associated virtual abutment or other component, eachrotatable about the other via their co-operable indices as directed byan automated and/or interactive clinical and/or digital protocol suchthat the virtual abutment is situated in a preferred, predeterminedvertical and horizontal position over the virtual implant prior to themilling of the physical abutment, the steps comprising rotation of thevirtual adaptor and virtual abutment such that said abutment becomesideally situated, selection of the appropriate virtual abutments foreach implant site from a library of said abutments and situating them,and milling the physical abutments as determined by the virtualreference points and the resulting preferred abutment geometry for anideally situated virtual abutment at each implant site.

In a preferred, but by no means only, embodiment, the co-operableabutments and other componentry have graduated reference points and/or amechanism of primary and secondary indicia that establish the rotationand synchronization points, and the referencing device is composed of avirtual universal aligning adaptor that has a specific primary indiciumto which all other cooperable componentry are synchronized. It is thesynchronization of all of the componentry that contributes to automatingthe restorative procedures with a dramatic reduction in operator error.

The virtual prosthetic component is rotated in either a predeterminedclockwise or counterclockwise direction over a virtual adaptor such thatthe primary reference indicium of said adaptor is positioned at aparticular primary or secondary indicium of said prosthetic component,resulting in the primary indicia of both components being situated inrelation to the index of the implant. This rotation can be performed inany software program for milling or fabricating prosthetic componentsand devices such that the scan code for the universal automated and/orinteractive clinical and/or digital protocol is capable of beingintegrated with the device controls of the program.

In certain embodiments, the rotation of the virtual aligning,synchronizing and referencing device in combination with the automatedand/or interactive clinical and/or digital protocol can be used in anyCT scan program to plan and visualize abutment type and rotation priorto surgery. As a result of this planning, the abutment can beprepackaged along with a designation of its insertion protocol includingthe appropriate primary or secondary rotation on the abutment forrotating the adaptor.

With this technique, the milled contour abutments or other prostheticcomponents can be used for restoring a crown, bridge, or set of crownswith an ideal emergence profile, angulation, tooth preparation form,gingival architecture or other aspects of an “ideal” crown and bridgeabutment. In addition, the milled multifunction abutments or otherprosthetic components are used to restore implants with a screw-downprosthesis, wherein the repositioning of the abutment ideally positionsthe screw access channels for receiving the prosthesis fixation screws,which improves contour, esthetics, and function. The system provides aversatile connection of the abutment to the implant. The milledabutment, other prosthetic component, or prosthetic device can be milledor fabricated by any other computer generated means such that it eitherengages the index of the adaptor with the assembly then being seated onthe implant, or can directly engage the index of the implant and beseated on the implant without the adaptor.

Due to the precise positioning of all components when fabricating andinserting them via the universal automated and/or interactive clinicaland/or digital protocol, the overlying coping, set of copings, or aframework for fabricating a set of splinted crowns can also befabricated to fit on the milled abutments, when clinical conditions areappropriate. This can be performed to a high degree of certainty, whenthe intraoral or bench scan are merged with the CT scan via theuniversal protocol. The prosthetic device can also be a screw bornefixed or removable prosthesis. Both the crown and bridge prosthesis andthe screw borne prosthesis can be seated on either milled or preformedabutments.

A Universal Set of Milled Contour Abutments for the Crown and BridgeRestoration Over Implants:

The Universal System can translate and integrate clinical contourhealing caps or abutments and other componentry prior to taking anintraoral or bench scan and/or CBCT scan using universal scanning postsseated on previously rotated universal aligning adaptors. The system canalso be used to translate and integrate data from an implant scan at thefixture level via its universal automated and/or interactive clinicaland/or digital protocol in a milling software program to create milledabutments and frameworks. The former technique is presented in thissection with the latter one having been presented in the previoussection (The Virtual Referencing Device for Intraoral or Bench Scanningand/or CBCT Scanning). In both methods, an overlaying milled frameworkor coping for a crown, set of crowns, or bridge is seated on preformedor milled anatomic abutments. Adaptors are rotated about chosen anglecorrecting abutments, having tooth preparations and gingival contourswith a variety of geometries, to predetermined positions as establishedby their co-operable indices and an automated and/or interactiveclinical and/or digital protocol such that the abutments are ideallysituated in preferred, predetermined vertical and horizontal positionsover their implants. Once positioned, universal scanning posts areseated on the indexes of said adaptors such that the co-operable indicesof the adaptor and the scanning posts register the newly establishedpositions of the abutments and the adaptors. The universal automatedand/or interactive clinical protocol is translated as a digital protocolby integrating the universal aligning scan code with the milling devicecodes and controls of a software program for milling prostheticcomponents, whereupon, a virtual rotation of each preferred abutmentover its universal aligning adaptor for each implant site as determinedby either the previous clinical rotation of the abutment or its by knownpredetermined points of rotation per implant index to ideally situate anabutment over a misaligned implant. The abutment is then milled for eachsite according to the parameters of the virtually rotated abutment, and,when appropriate, the copings or framework that will be receiving aporcelain, composite, or other veneering material are milled to fit overthe abutments. Once the copings and/or framework are completed, themilled abutments are positioned on their respective implants with themilled coping(s) or framework then being inserted over the abutments. Itthe final veneering material has not been applied, the coping(s) orframework are lifted in an impression, models are poured and mounted,and the final restoration is fabricated. These steps can also beapplied. Once again, the framework and/or copings can be milled to fitpreformed abutments that have already been seated or to be seated ontheir implants.

In a preferred, but by no means only, embodiment, the co-operableabutments and other componentry have graduated reference points and/or amechanism of primary and secondary indicia that establish the rotationand synchronization points, and the virtual abutment is composed of avirtual universal aligning adaptor that has a specific primary indiciumto which all other cooperable componentry are synchronized. It is thesynchronization of all of the componentry that contributes to automatingthe restorative procedures with a dramatic reduction in operator error.

The automated and/or interactive clinical and/or digital protocolincludes selecting the appropriate vertical angle correcting abutment orother prosthetic component having the desired geometric shape for thattype of restoration over the implant from a library, rotating it asnecessary in either a predetermined clockwise or counterclockwisedirection such that the primary indicium of the adaptor is positioned ata particular primary or secondary indicium point of the abutment and isset in relation to the index of the implant when the prostheticcomponent is being situated in a preferred, predetermined horizontal andvertical position over the implant.

In certain embodiments, a universal aligning, synchronizing andreferencing device that is used to clinically to establish the preferredposition of a seated abutment along with the location of the primary andsecondary indicia or other indicia means for referencing the desiredposition, which is followed by a virtual rotation of the appropriateabutment for a particular restoration at that implant site in a softwareprogram, prior to milling the abutment or framework.

The rotation of the abutment or the virtual aligning, synchronizing andreferencing device in combination with the automated and/or interactiveclinical and/or digital protocol can be performed in any millingsoftware program having the universal aligning scan code which includesthe universal automated and/or interactive clinical and/or digitalprotocol. With this technique, the virtual abutment is auto-rotated byinputting the primary or secondary rotation point that is overlaying theprimary indicium of the adaptor when the abutment is preferentiallysituated, automatically positioning the virtual abutment such that itsprimary indicium is in the established position of the clinicallyrotated and inserted healing cap or abutment.

Fully anatomic abutments with specific “tooth” abutment preparations andgingival contours are then planned for each implant site, thereinrequiring very precise positioning of the abutments for paralleling thetooth preparations and for establishing the appropriateabutment/gingival relationships, which is accomplished either prior toimpression taking or scanning and/or is performed digitally in asoftware program after the initial referencing. A virtual biteregistration is taken as a part of the process of taking an intraoral orbench scan and/or CBCT scan, and may be repeated after the framework isfabricated.

In certain embodiments, the adaptors and healing caps have been rotatedand inserted over the implants in preferred positions without theabutments, themselves, being in place, wherein the healing caps areremoved, scanning posts are inserted over the repositioned adaptors suchthat their primary indicia overlay, and an intraoral scan and/or CBCTscan is taken and the abutments and framework are then fabricated. Theabutments are either milled to the adaptor's index or directly to engagethe implant index. In another embodiment, the framework, alone, ismilled and seated on preformed, ideally positioned abutments having thepreferred configuration and position.

In certain embodiments, the abutment has been rotated such that itsprimary indicium is ideally located on the buccal, and a lingual crownfixation screw thread is milled to receive a crown fixation screw whichis in a range of locations on the lingual surface which is approximately180° from the primary indicium of the abutment such that a crownfixation screw is inserted to aesthetically and retrievably secure thecrown, set of crowns, or bridge. After the completion of the above stepsfor the cement-on or screw retained crowns, the crown veneer isfabricated by stacking porcelain or other veneering material or ismilled from an appropriate restorative material

In certain embodiments, the scanning program fabricates a working modelwith replicas of the preformed or milled contour abutments that areaseated on analogs for each implant site such that they are situated asdeveloped in the program. As an alternative model formation, thescanning program fabricates a model with milled receptacles at eachimplant site to receive universal aligning analogs that are inserted bythe technician to fabricate the screw borne prosthesis. The universalaligning analog has an index at the open end with the same configurationas the adaptor's abutment engaging index, configuration, and position,and its shank has the same polygonal configuration as the free end ofthe adaptor that engages the index of the implant being restored. Theuniversal aligning analog and abutment can be removed, rotated abouteach other and then rotated as an assembly, and seated in the model toallow the abutment to be placed in a preferred position.

Forming a Set of Universal Milled Multifunction Abutments for the ScrewBorne Prosthesis over Implants:

The Universal Multifunction Abutment realigns the screw access holes forany fixed or removable screw borne prosthesis. Universal System's uniqueautomated and/or interactive clinical and/or digital protocol translatesand integrates clinical multifunction abutments and other componentryprior to taking an intraoral or bench scan and/or CBCT scan usinguniversal scanning posts seated on previously rotated universal aligningadaptors or provides said translation and integration of virtualcomponentry in a software program after the scan data is received priorto the fabrication of a set of milled multifunction abutments and/orprosthetic devices. A method of fabricating a set of milled abutmentsand/or an overlaying milled framework for a screw borne prosthesisseated on screw retaining multifunction abutments by using either a fullor a segmented arch intraoral or bench scan or a CT scan, the stepscomprising the rotation of adaptors and chosen angle correcting,multifunction abutments about each other to predetermined positions asestablished by their co-operable indices and an automated and/orinteractive clinical and/or digital protocol such that the abutments areideally situated in preferred, predetermined vertical and horizontalpositions over their implants, inserting universal scanning or imagingposts on the indexing polyhedrons of the multifunction abutments suchthat their co-operable indices and those of the scanning or imagingposts register the newly established positions of the abutments and theadaptors when the intraoral or bench scan or CT scan is taken,translating the automated and/or interactive clinical protocol to adigital protocol by integrating the universal aligning scan code withthe milling device codes and controls of a software program for millingprosthetic components within the software program, performing a virtualrotation of each preferred abutment over its universal aligning adaptorfor each implant site until each one is ideally situated, milling thescrew retaining abutment for each site based on the parameters of thevirtually rotated abutment, milling the framework to fit over theabutments that will be integrated into the prosthesis, if possible,inserting the milled abutments on their respective implants andinserting the milled framework over the abutments, and affixing theframework with impressions screws which are long enough to fit throughan impression tray, taking an impression and unscrewing it such that theframework is lifted with the impression when it is removed from themouth, fabricating the models, taking bite registrations, mounting themodels, and fabricating the final restoration.

In a preferred, but by no means only, embodiment, the co-operablemultifunction abutments and other componentry have graduated referencepoints and/or a mechanism of primary and secondary indicia thatestablish the rotation and synchronization points, and the virtualabutment is composed of a virtual universal aligning adaptor that has aspecific primary indicium to which all other cooperable componentry aresynchronized. It is the synchronization of all of the componentry thatcontributes to automating the restorative procedures with a dramaticreduction in operator error.

The automated and/or interactive clinical and/or digital protocolincludes selecting the appropriate vertical angle correctingmultifunction abutment or other prosthetic component having the desiredgeometric shape from a library, rotating it as necessary in either apredetermined clockwise or counterclockwise direction such that theprimary indicium of the adaptor is positioned at a particular primary orsecondary indicium point of the abutment and is set in relation to theindex of the implant when the prosthetic component is being situated ina preferred, predetermined horizontal and vertical position over theimplant.

The rotation of the virtual multifunction abutment, in combination withthe automated and/or interactive clinical and/or digital protocol, canbe performed in any milling software program having the scan code forsaid device. In certain embodiments, the abutment can be automaticallyrotated in the software program by indicating which primary or secondaryrotation point is overlaying the primary indicium of the adaptor, suchthat it automatically positions the abutment with its primary indiciumin the established position of the clinically rotated and insertedmultifunction abutment.

In certain embodiments, the adaptors and healing caps or interimabutments are seated on the implants after having been repositioned suchthat their primary indicia bisect the ridge at a 90° angle in thesagittal plane, and when said healing caps are removed, the primary orsecondary indicia overlaying the primary indicia of their adaptor areidentified, scanning or imaging posts are inserted over the adaptorssuch that their primary indicia overlay each other, and an intraoralscan is taken to reference the primary indicia of the adaptors, which,when combined with the location of the adaptor in relation to theprimary or secondary indicia of the healing caps, uniquely identifiesthe preferred position of the healing caps. The virtual multifunctionabutments are rotated such that their primary or secondary indiciaoverlay the primary indicia of the virtual adaptors and are milled. Themultifunction abutments can be milled to fit on adaptors or to directlyengage the implants' index. The framework is then milled to fit theabutments.

In certain embodiments, an impression post is seated at the samelocation on the implants and an impression is taken, a model is poured,and a bench scan is taken.

The framework, alone, can be milled and seated on preformedmultifunction abutments that are situated with their reference points inthe same locations as the virtual abutments.

In certain embodiments, a bite block is milled to fit over the frameworkand is returned with the milled abutments and framework such that theabutments, framework, and milled bite block are seated with a bite andaesthetic registration being taken to establish the vertical bite, smileline and other denture parameters, prior to taking a transferimpression.

In certain embodiments, the precise repositioning of the screw accessholes such that they more closely approximate the occlusal tables of thereplacement teeth, a full arch of screw retained crowns can befabricated without flanges. The patient can now receive a full arch ofscrew retained crowns in preference to a screw retained denture havingacrylic flanges, which is applicable to either the standard fabricationprocess after implants have integrated or to the immediate load screwretained transitional hybrid denture conversion process that isperformed at the time of implant insertion. The net benefit is asignificant improvement in patient hygiene, when the flanges areeliminated. Esthetics in many cases is also vastly improved.

Using the Universal Aligning Analog

A universal aligning analog model can be either fabricated by a dentaltechnician in the laboratory or is fabricated by a computer softwareprogram. Both models have receptacles for receiving the universalaligning analog, which has an index at the open end with the sameconfiguration as the adaptor's abutment engaging index, configuration,and position, and has a shank with the same polygonal configuration asthe free end of the adaptor that engages the index of the implant beingrestored. For example, if a 15° angle correction is wanted for thehexagon implant, then the top index of the analog is an octagon and theshank is a tapered hexagon. The universal aligning analog and abutmentcan be rotated and reseated into the receptacle in the model to allowthe abutment to be placed in a more preferred position. The universalaligning analog also has a referencing indicium that is rotated in thesame manner as the adaptor such that the indicium is positioned underone of the primary or secondary indicia of the abutment being rotated.

If an abutment an abutment has been rotated to one of its alternativeprimary or secondary indicia on the analog, the restorative dentistmerely rotates it over the adaptor seated on that particular implant.

The universal aligning adaptor is particularly useful with the immediateload transitional hybrid conversion technique for ideally positioningscrew access holes.

Methods of Inserting and Restoring the Nonagon Implant

In certain embodiments, the automated and interactive clinical and/ordigital protocol when restoring the Universal Nonagon Implant with aprimary indicium includes choosing the appropriate vertical anglecorrecting abutment or other prosthetic component having the desiredgeometric shape for that type of restoration over the implant, rotatingit as necessary in either a predetermined clockwise or counterclockwisedirection such that the primary indicium of the adaptor is positioned ata particular primary or secondary indicium point of the abutment and isautomatically set in relation to the index of the implant when theprosthetic component is being positioned in a preferred, predeterminedhorizontal and vertical situation over the implant as determined by theprimary indicium (FIG. 99B). The Nonagon Implant, in association withthe Universal Aligning Adaptor having an octagon abutment engagingprojection, has a distinct advantage over all other implant indexes withits 5° increments of rotation guided by its primary indicium.

In certain embodiments, the implant has a nonagon index which, beingsymmetrical, allows for abutment rotation, while one of the verticesserves as a primary indicium or vertex and reference point for all ofthe co-operable indicia of its componentry, since it is the only vertexthat bisects the opposing flat at a 90° angle that is located 180° awayfrom it in the sagittal plane.

In certain embodiments, the fixture mount that carries the implant tothe osteotomy site and is used with an engaging tool to secure theimplant in the bone has a primary indicium or vertex that indicates thelocation of the implant's primary indicium or vertex that assists thesurgeon with placing the implant with its index ideally situated. Afterthe fixture mount is removed, the insertion tool that engages theimplant index can also have a primary indicium that guides the surgeonas he completes the insertion of the implant in order to ideallyposition the implant index.

In one embodiment, a method of restoring a Universal Aligning Implanthaving any index configuration and alignment with a referencing indiciumby realigning, synchronizing, and referencing restorative prostheticcomponents to set reference points to realign and synchronize an implantprosthetic insert. The restorative dentist can choose the desiredvertical angle correcting prosthetic component having the appropriategeometric shape for restoring the implant. The prosthetic component canbe rotated over a prosthetic insert with the assembly over the implantin 5° increments via co-operable indicia on the component and prostheticinsert such that the prosthetic component is ideally situated in aposition. When in the ideal position, the co-operable indicia can beidentified at that position, and the reference points can be used forfabricating the final prosthetic components.

The co-operable indicia can include graduated reference points and/orprimary and secondary indicia that establish the rotation andsynchronization points.

All componentry can be synchronized to the primary indicium of theadaptor, to the specific primary or secondary indicium of the prostheticdevice that overlays the primary indicium of the adaptor, and to theprimary indicium of the prosthetic component which defines its preferredhorizontal and vertical position.

In certain embodiments, identifying the rotation and synchronizationpoints prior to taking an impression for a bench scan, automaticallyidentifies and references them during the bench scan, and, thereby,lessens the effects of any distortion that can occur from expansion andcontraction of materials, when taking an impression for fabricating amodel.

At least one embodiment provides a method of restoring a dental implanthaving an index of “n” sides, one of which has the primary indicium,that has been inserted in the jaw with an arbitrary alignment of theindex by combining a prosthetic insert whose mutual geometry at its endthat extends into the implant index and at its end that receivesprosthetic components having co-operable indices allows for a directedrotation of the components, such that they are first decoupled fromdependence upon the coarse rotations around the implant's index, and arethen aligned and synchronized according to an automated and/orinteractive clinical and/or digital protocol, wherein the prostheticcomponents are rotated about a reestablished vertical axis of rotationwhich results in more refined increments of the rotation using either apredetermined counter or straight rotation to ideally situate theprosthetic components and to synchronize them to a defined referencepoint or set of reference points on the prosthetic insert, which is thenidentified and referenced for fabricating the restoration that is seatedon the implant. Therefore, in at least certain embodiments, it ispossible for one or more scanners and associated computers to recognizeor identify this primary indicium automatically. This computeridentified primary indicium enables autorotation of the virtual abutmentsuch that it is ideally situated prior to milling the physical abutmentand the overlying prosthetic device.

Certain embodiments provide a method of using a universal aligningimplant for restoring an edentulous site wherein it has a primaryindicium as a reference point in its index to better position it in anideal alignment in the ridge along with a set of prosthetic componentrythat are synchronized to the implant's primary reference points and toeach other via their co-operable indicia when the implant is restoredsuch that the abutment and/or overlaying prosthesis is in an idealposition or, in combination with an aligning, synchronizing, referencingdevice and an automated and interactive clinical and/or digitalprotocol, reestablishes the preferred abutment position. The implant canbe inserted such that its primary indicium is situated in a sagittalplane that bisects the ridge at a 90° angle, inserting an impressionpost, scanning post, or other referencing device into the implant suchthat the primary indicium of the referencing device is aligned with theprimary indicium of the implant. When aligned a final abutment orprosthesis can be fabricated that is seated on the implant such that itsprimary indicium is overlaying the implant's primary indicium, and is,therein, ideally positioned over the implant.

In certain embodiments, the fixture mount that carries the implant tothe osteotomy site and is used with an engaging tool to secure theimplant in the bone has a primary indicium that indicates the locationof the implant's primary indicium wherein the surgeon is able to ideallyalign the implant index.

In certain embodiments, the insertion tool that engages the implantindex has a primary indicium that guides the surgeon as he completes theinsertion in order to ideally position the implant index. The set ofprosthetic componentry can have co-operable primary and secondaryindicia or other co-operable indicia are used in combination with theautomated and interactive clinical and/or digital protocol when theprimary indicium of the implant does not bisect the ridge at a 90° anglein the sagittal plane, wherein the adaptor and the prosthetic componentare rotated individually and as an assembly as determined by theprotocol such that their primary and secondary indicia reposition thedevice to an ideal position in order to compensate for the implant'smisalignment.

FIG. 103 depicts a system 10300 for use in producing properly fittingand aesthetic dental fixtures according to various embodiments. Thesystem 10300 may, in general, include a scanning component 10314, acorrection component 10316, and a manufacturing system 10318. Thescanning component 10314 may include a scanning computer 10302 a and ascanner 10302 b. The scanner may be any appropriate scanner for takingscans of aspects of a patent's mouth. For instance, according to someembodiments, the scanner may comprise an intraoral scanner or a conebeam computed tomography (CBCT) scanner. As discussed above, the scanner10302 b may be operable to scan the scanning post 700 and record therelative position of its various indicia (e.g., primary indicia 713 and714 and secondary indicium 715) in space. Additionally, the scanner maybe operable to perform an oral scan without the use of scanning post 700such that virtual indicia may later be extracted from the scan data.

The scanning computer 10302 a may receive data from the scanner 10302 band compile and/or process the data to achieve a usable scan data. Thescan data may include information about the oral geometry of a patient.If using scanning post 700, the scan data may include informationindicative of the relative position of the various indicia and/orvirtual indicia. The scan data may also contain information relating toa patient's oral features (e.g., the relative position of teeth, gums,and other tissue). Additionally, the scanning computer 10302 a may beconfigured to transmit the scan data to the correction component 10316via communication channel 10320.

The correction component 10316 may comprise a system 10304 that isconfigured to receive the scan data from the scanning component 10314via communication channel 10320. System 10304 may include acommunications interface 10306 suitable for communicating with variouscommunications channels 10320 10322, a memory 10308, and a controller10310. Additionally, correction component 10316 may be operable tocommunicate with manufacturing component 10318 via communication channel10322. According to various embodiments, the correction component 10316is operable to generate appropriate manufacturing instructions for theproduction of a dental fixture based on the received scan data and, inparticular, the scanned indicia and/or virtual indicia. For instance, ifthe correction component 10316 determines that one or more of theindicia (actual or virtual) indicate a misalignment, the correctioncomponent 10316 can generate appropriate manufacturing instructions thatoffset and account for the misalignment in the dental fixture.

Manufacturing component 10318 may comprise a manufacturing computer10312 a coupled to a production facility 10312 b. The manufacturingcomputer 10312 a may be configured to receive manufacturing instructionsfrom the correction component 10316 via communication channel 10312.Additionally, the manufacturing computer 10312 a may be configured tocompile and/or parse the instructions to place them in suitable form forthe production facility 10312 b.

FIG. 103 depicts system 10300 as having a single scanner component10314, a single correction component 10316, and a single manufacturingcomponent 10318. However, this need not be the case. It is also possibleto have a plurality of each of components 10314, 10316, and 10318 in thesystem 100. Such an embodiment is depicted in FIG. 104 .

FIG. 104 is a functional block diagram depicting a system 10400 with aplurality of scanner components 103141, 103142, . . . , 10314N(collectively referred to as scanner components 10314), a correctioncomponent 10316, and a plurality of manufacturing components 103181,103182, . . . , 10318M (collectively referred to as manufacturingcomponents 10318). While only a single correction component 10316 isshown in FIG. 104 , it should be understood that system 10400 maycontain a plurality of correction component 10316. Each of the scannercomponents 10314, the correction component 10316, and the manufacturingcomponents 10318 is connected to an electronic communication network10402.

In practice, a system such as system 10400 allows for increasedflexibility in receiving scan data and in producing the dental fixture.For instance, correction component 10316 can be configured to receivemultiple instances of scan data relating to a single patient frommultiple scanner components 10314. By way of example, scanner component103141 may be able to only provide intraoral scan data to correctioncomponent 10316 and scanner component 103142 may only be configured toprovide CBCT scan data to correction component 10316. The correctioncomponent 10316 can then merge the scan data to generate more accuratemanufacturing instructions. These manufacturing instructions can, then,be sent to one of the appropriate manufacturing components 10318 forexecution. The appropriate manufacturing component 10318 can be selectedbased on, for instance, physical proximity, workload, productionfacilities, etc. Thus, a system that allows a correction component 10316to interact with a number of different scanner components 10314 and anumber of different manufacturing components 10318 allows for greaterflexibility.

FIG. 105 is a flow chart depicting a method 10500 of fabricating adental fixture using scan data according to various embodiments.According to method 10500 one or more scans can be performed at step10502 by, for instance, scanner 10302 b. The scan or scans may comprise,intraoral scans, CBCT scans, x-ray scans, or any suitable scan capableof taking appropriate oral measurements. After the scan or scans areperformed scan data can be generated and sent to the correctioncomponent 10316 at step 10504.

At step 10506, the correction component 10316 can extract indicia fromthe scan data. For instance, if a scanning post 700 was used, thecorrection component 10316 can extract the primary and secondary indicia713, 714, and 715. Alternatively, virtual indicia may be generated basedon, for instance, a sidewall of the scanning post or various otherfeatures of the implant and/or the patients features.

At step 10508, the correction component 10316 can determine whether acorrection is needed in the dental fixture based on the scan data. Forinstance, the correction component 10316 may determine that the indicia(actual or virtual) indicate a misalignment of the implant 10. Once adetermination is made about whether correction is needed at step 10508,appropriate manufacturing instructions can be generated at step 10510.For instance, if the correction component 10316 determines that theindicia indicate a misalignment, the manufacturing instructions canaccount for the misalignment by offsetting, rotating, or otherwisecancelling out the misalignment in the manufacturing instructions. Themanufacturing instructions can then be sent to the manufacturingcomponent 10388 at step 10512 and the dental fixture can be produced bythe production facility 10312 b.

FIG. 106 is a flow chart depicting a method 10600 of generating theappropriate manufacturing instructions based on received scan dataaccording to various embodiments.

The method may be performed by any suitable component such as correctioncomponent 10316. According to the method 10600, scan data is received atstep 10602 from, for instance, scanning component 10314. At step 10604,one or more indicia are determined from the scan data. If, for instance,a scan post is used (e.g., scan post 700), then actual indicia (e.g.,primary and secondary indicia 713, 714, and 715) can be extracted fromthe scan data and their relative positions determined. However,according to some embodiments, the indicia may be determined bygenerating virtual indicia based on various features of the scan data.

At step 10606, the indicia are examined to determine whether correctionis needed. For instance, the indicia can be analyzed to determinewhether there will be a misalignment in the dental fixture if it isinserted into position. This can happen when the indicia are offsetspatially from where they are otherwise expected in the x, y, or zdirections. If, at step 10606, it is determined that a correction isneeded, then an appropriate offset and/or correction is computed toadjust for the misalignment. This offset and/or correction can be usedto generate appropriate manufacturing instructions at step 10610. If, onthe other hand, it is determined that no correction is needed at step10606, then the manufacturing instructions for the dental fixture can begenerated without computing an offset and/or correction at step 10610.Finally, at step 10612, the instructions can be sent to the productionfacility so that the dental fixture can be produced.

FIG. 107 is a flow chart depicting a method 10700 of generating theappropriate manufacturing instructions based on received scan dataaccording to various embodiments.

The method may be performed by any suitable component such as correctioncomponent 10316. According to the method 10700, first scan data isreceived at step 10702 from, for instance, scanning component 103141(shown in FIG. 104 ). At step 10704, second scan data can be receivedfrom, for instance, scanning component 103142. While not necessary, itis possible for the first and second scan data to be generated usingdifferent scanning methods. By way of example, it would be possible forthe first scan data to be generated using an intraoral scanning deviceand for the second scan data to be generated by a CBCT scan. At anyrate, the scans need not be of the same type.

At step 10606, one or more indicia are determined from each of the firstand second scan data. If, for instance, a scan post is used (e.g., scanpost 700), then actual indicia (e.g., primary and secondary indicia 713,714, and 715) can be extracted from the scan data and their relativepositions determined. However, according to some embodiments, theindicia may be determined by generating virtual indicia based on variousfeatures of the scan data.

At step 10706, the data from the first and second scan data can bemerged to generate a combined set of scan data. The first and secondscan data can be merged by aligning like indicia so that the relativeposition of the various scanned features is known. This merging ofmultiple kinds of scan data allows for a more complete picture of apatient's oral features. Continuing with our example where the firstscan data comprises intraoral scan data and the second scan datacomprises CBCT scan data, the advantage of this process can be seen;intraoral scans register soft tissue (e.g., the gum line, etc.) betterand CBCT scans register bone (e.g., teeth) and metallic objects (e.g.,implant 10) better. Accordingly, it is possible, by merging the twokinds of scan data to have a better view of the soft tissue in relationto the bone and metallic objects and to, therefore, generate a bettercorrection.

At step 10710, the merged scan data is examined to determine whethercorrection is needed. For instance, the indicia can be analyzed todetermine whether there will be a misalignment in the dental fixture ifit is inserted into position. This can happen when the indicia areoffset spatially from where they are otherwise expected in the x, y, orz directions. If, at step 10710, it is determined that a correction isneeded, then an appropriate offset and/or correction is computed at step10712 to adjust for the misalignment. This offset and/or correction canbe used to generate appropriate manufacturing instructions at step10714. If, on the other hand, it is determined that no correction isneeded at step 10710, then the manufacturing instructions for the dentalfixture can be generated without computing an offset and/or correctionat step 10712. Finally, at step 10716, the instructions can be sent tothe production facility so that the dental fixture can be produced.

In an embodiment, the system and components described herein areimplemented using well known computers, such as computer 10800 shown inFIG. 108 . For instance, any of the hardware and/or software processesdepicted in FIGS. 103-105 could be performed by a computer or computerssuch as computer 10800.

Computer 10800 may comprise any commercially available computer capableof performing the functions described herein, such as computersavailable from International Business Machines, Apple, Sun, HP, Dell,Digital, Cray, etc.

Computer 10800 includes one or more processors (also called centralprocessing units, or CPUs), such as a processor 10806. Processor 10806may comprise one or more processors. The processor 10806 is connected toa communication bus 10804. Processors 10806 may include any conventionalor special purpose processor, including, but not limited to, digitalsignal processor (DSP), field programmable gate array (FPGA), andapplication specific integrated circuit (ASIC).

Computer 10800 includes one or more graphics processing units (alsocalled GPUs), such as GPU 10807. GPU 10807 is a specialized processorthat executes instructions and programs selected for complex graphicsand mathematical operations in parallel.

Computer 10800 also includes a main or primary memory 10808, such asrandom access memory (RAM). The primary memory 10808 has stored thereincontrol logic 10828A (computer software), and data.

Computer 10800 also includes one or more secondary storage devices10810. The secondary storage devices 10810 include, for example, a harddisk drive 10812 and/or a removable storage device or drive 10814, aswell as other types of storage devices, such as memory cards and memorysticks. The removable storage drive 10814 represents a floppy diskdrive, a magnetic tape drive, a compact disk drive, an optical storagedevice, tape backup, USB Flash memory, etc.

The removable storage drive 10814 interacts with a removable storageunit 10816. The removable storage unit 10816 includes a computer useableor readable storage medium 10824 having stored therein computer software10828B (control logic) and/or data. Removable storage unit 10816represents a floppy disk, magnetic tape, compact disk, DVD, opticalstorage disk, USB Flash memory, or any other computer data storagedevice. The removable storage drive 10814 reads from and/or writes tothe removable storage unit 10816 in a well-known manner.

Computer 10800 also includes input/output/display devices 10822, such asmonitors, keyboards, pointing devices, touch-screen displays, etc.

Computer 10800 further includes a communication or network interface10818. The network interface 10818 enables the computer 10800 tocommunicate with remote devices. For example, the network interface10818 allows computer 10800 to communicate over communication networksor mediums 10824B (representing a form of a computer useable or readablemedium), such as LANs, WANs, the Internet, etc. The network interface10818 may interface with remote sites or networks via wired or wirelessconnections.

Control logic 10828C may be transmitted to and from computer 10800 viathe communication medium 10824B. More particularly, the computer 10800may receive and transmit carrier waves (electromagnetic signals)modulated with control logic 10830 via the communication medium 10824B.

Any apparatus or manufacture comprising a computer useable or readablemedium having control logic (software) stored therein is referred toherein as a computer program product or program storage device. Thisincludes, but is not limited to, the computer 10800, the main memory10808, the secondary storage devices 10810, the removable storage unit10816 and the carrier waves modulated with control logic 10830. Suchcomputer program products, having control logic stored therein that,when executed by one or more data processing devices, cause such dataprocessing devices to operate as described herein, representembodiments.

Although, several of the preferred embodiments of the present inventionshave been shown and described above, other embodiments will be readilyapparent to those skilled in the art. Therefore, the scope of thepresent invention is not limited to the specific embodiments shown anddescribed, but, rather, is defined in the appended claims.

For the Examiner's convenience, given the complexity of the presentsystem and the interrelationship of the various part numbers used in thepresent application, Applicant has provided the following parts listtable. It is understood that the detailed description is controlling andthat the description in this parts list is for convenience sake only. Inother words, the part list does not limit the claims or the descriptionof the system in the detailed description.

10 implant 12 internal threaded portion 15 index 21 trichannel 22hexagon 23 dodecagon 24 octagon 25 nonagon 100 Universal AligningAdaptor 111 octagon projection 120 primary reference indicium on octagon121 primary reference indicium on collar 122 indicia in increments 128centerline for external hexagon 130 collar on adaptor 140 index tointerface with the implant 141 trilobe external index 145 nonagonexternal index 151 channel for screw 152 thread for abutment screw 171Universal Aligning Analog with recess for set screw 173 universal analogexternal configuration of shank 174 screw hole to receive set screw 200Universal Fixation Screw 210 shank 220 thread 230 internal hex 240shoulder of screw head 300 Universal Contour Abutment 321 primaryindicium on collar of post 322 (A) first indicium clockwise rotationstop 324 (C) third indicium clockwise rotation stop 325 (a) firstindicium counter clockwise rotation stop 326 (b) second indicium counterclockwise rotation stop 330 standard gingival contours 331 collarscalloped gingival contour-generic 332 collar gingival shape-contourAnterior 333 collar gingival shape-contour medium posterior 334 collargingival shape-contour large posterior 337 collar-cylindrical 338gingival depth extension 340 custom gingival contours 344 maxillarypremolar tooth preoaration 351 15° horizontal angle correction 353 0°vertical angle correction 354 15° vertical angle correction 356 30°vertical angle correction 361 octagon indexing 362 hexadecagon indexing363 hexagon indexing 364 dodecagon (12 sided) indexing 365 screw accesschannel 367 rotation of abutment/adaptor mating index 369 open end atthe base 372 tooth preparation chamfer 373 tooth preparation for anabutment 390 screw down crown 391 crown fixation screw 392 thread toreceive crown fixation screw 393 channel in crown to receive crownfixation screw 400 universal asymmetric contour healing cap 401universal asymmetric indexed contour healing cap 402 universalcylindrical (symmetric) healing cap 403 universal cylindrical(symmetric) indexed healing cap 404 symmetrical, cylindrical indexedhealing cap to implant 405 asymmetric contour indexed healing cap toimplant 406 aligning external index 407 universal scalloped top contourhealing cap 408 recessed polyhedron for impression/scan/abutment 409universal scalloped top indexed contour healing cap 411 primary indiciaon collar 415 (a) first indicium counter clockwise rotation stop 418Primary indicium 421 primary indicia on top of healing cap 422 (A) firstindicium clockwise rotation stop 423 (B) second indicium clockwiserotation stop 424 (C) third indicium clockwise rotation stop 425 (a)first indicium counter clockwise rotation stop 426 (b) second indiciumcounter clockwise rotation stop 427 (c) third indicium counter clockwiserotation stop 428 primary indicium on the external index on top of thehealing cap 430 standard gingival contours 433 collar gingivalcontour-medium posterior 437 collar-cylindrical 441 maxillary centralincisor 442 maxillary lateral incisor 443 maxillary canine 444 maxillarypremolar 445 maxillary molar 446 mandibular incisor 447 mandibularcanine 448 mandibular 1st premolar 449 mandibular 2nd premolar 500Universal Multifunction Abutment 520 primary indicium 521 primaryindicium on collar 523 (B) second indicium clockwise rotation stop 525(a) first indicium counter clockwise rotation stop 526 (b) secondindicium counter clockwise rotation stop 528 center line of an internaloctagon flat 529 off center line 544 maxillary premolar 551 abutmentrotating in 15° increments 553 0° vertical angle correcting abutment 55630° vertical angle correcting abutment 557 misaligned abutment fromcentral axis 558 aligned abutment to central axis 559 center line of theangle correcting abutment 561 octagon 565 screw access channel 572 coneon abutment 573 flat surface on the cone 574 internal thread in the cone575 cylinder fixation screw 580 cylinder 581 flat surface positionedover flat of cone 582 mm score lines 583 internal threads to securefixation screw 584 internal threads to receive sealing screw 585 sealingscrew 586 bonding sleeve 589 external configuration for retention 600Universal Impression Post 601 universal impression post over adaptor 602universal impression post over healing cap 603 universal impression postover multifunction abut 604 Universal Impression Post plus transf 611flat on impression post overlying reference adaptor flat 612 matingprojections for top of healing cap 621 primary indicium on collar 637collar-cylindrical 661 collar-cylindrical 665 screw access channel 672transfer cap-direct impression 673 transfer cap-through the tray 700Universal Scanning Post 712 mating projections for top of healing cap713 X sphere protrusion 714 y rectangle protrusion 715 z triangleprotrusion 800 Universal Guided Tissue Punch 801 surgical guiding screw802 cutting edge of tissue punch 803 internal guiding polyhedron 804universal guided tissue punch-implant insertion 805 surgical guidingcylinder 810 universal paralleling posts 811 stem of the parallelingpost 812 abutment head of the paralleling post 815 adaptorcarrier/releasing screw tool 816 primary indicium on the shank 818releasing screw 900 Nonagon Implant 901 Internal nonagon implant index920 Primary vertex of nonagon index 921 “0” reference indicium on top ofimplant collar 930 fixture mount 931 external nonagon index of fixturemount to implant 932 external nonagon index of fixture mount shank 933vertex configuration overlying vertex of nonagon

What is claimed is:
 1. A method for dental restoration comprising:rotating one or both of an adaptor seated on an implant in a patient'sjaw and having an adaptor reference indicium and a prosthetic componenthaving a prosthetic reference indicium that is co-operable with theadaptor reference indicium relative to each other to position theprosthetic component into a vertical and horizontal predeterminedposition in relation to the implant; generating position data byregistering the vertical and horizontal predetermined position;translating, via a computer, the position data into manufacturing devicecodes that control a milling or printing program; manufacturing a secondprosthetic component based on the manufacturing device codes; andinserting the manufactured second prosthetic component on the implantsuch that the manufactured second prosthetic component is in a preferredposition.
 2. The dental restoration method of claim 1, wherein theposition data is generated by an intraoral scan, CBCT scan, or otherscan device of the adaptor or prosthetic component.
 3. The dentalrestoration method of claim 1, wherein the adaptor reference indiciumand the prosthetic reference indicium include graduations for indicatingthe degree of rotation of the prosthetic component and adaptor relativeto each other.
 4. The dental restoration method of claim 1, wherein therotating is performed virtually in a software, wherein the adaptorincludes a digital adaptor reference indicium and the prostheticcomponent includes a digital prosthetic reference indicium co-operablewith the digital adaptor reference indicium, such that the digitaladaptor reference indicium is rotatable in relation to the digitalprosthetic reference indicium to define the vertical and horizontalpredetermined position.
 5. The dental restoration method in claim 4,wherein the prosthetic component is a base of a final abutment with theconfiguration to match the configuration of a healing cap.
 6. The dentalrestoration method of claim 4, wherein a rotational relationship of anoctagon stud on an open end of the adaptor to receive the prostheticcomponent and a tripod, hexagon, or dodecagon stud on a free end of theadaptor which interfaces with a corresponding implant index results in avirtual horizontal rotation of the prosthetic component in 15°increments of horizontal rotation when an engaging receptacle of theprosthetic component is an octagon.
 7. The dental restoration method ofclaim 4, wherein a rotational relationship of an octagon stud on an openend of the adaptor to receive the prosthetic component and a tripod,hexagon, or dodecagon stud on a free end of the adaptor which interfaceswith a corresponding implant index results in a virtual horizontalrotation of the prosthetic component in 7.5° increments of horizontalrotation when an engaging receptacle of the prosthetic component is ahexadecagon.
 8. The dental restoration method of claim 4, wherein arelationship of a hexagon stud on an open end of the adaptor to receivethe prosthetic component and an octagon stud on a free end of theadaptor that interfaces with a corresponding octagon implant indexresults in a virtual horizontal rotation of the prosthetic component in15° increments of horizontal rotation when an engaging receptacle of theprosthetic component is a hexagon.
 9. The dental restoration method ofclaim 4, wherein a relationship of a hexagon stud on an open end of theadaptor to receive the prosthetic component and an octagon stud on afree end of the adaptor that interfaces with a corresponding octagonimplant index results in a virtual horizontal rotation of the prostheticcomponent in 7.5° increments of horizontal rotation when an engagingreceptacle of the prosthetic component is a dodecagon.
 10. The dentalrestoration method of claim 4, wherein a polygonal structure at an openend of the adaptor is a nonagon stud and a free end of the adaptor is aquadragon or octagon and the prosthetic component has an nonagonreceptacle that engages the nonagon stud of the adaptor such that theinterface results in net 10° increments of horizontal rotation whenengaging the receptacle of the prosthetic component.
 11. The dentalrestoration method of claim 4, wherein a polygonal structure at an openend of the adaptor is a quadragon or octagon stud and a free end of theadaptor is a nonagon and the prosthetic component has a quadragon oroctagon receptacle that engages the quadragon or octagon stud of theadaptor such that the interface results in a net 10° or 5° increments ofhorizontal rotation when engaging the receptacle of the prostheticcomponent.
 12. The dental restoration method of claim 4, furthercomprising: taking an impression of the implant to create an implantanalog; performing a scan of the implant analog and creating data basedon the positioning of the implant analog; and conveying the data to themilling program.
 13. The dental restoration method of claim 1, whereinthe manufactured second prosthetic component is manufactured by amilling device or a three-dimensional printer.
 14. A method for dentalrestoration comprising: rotating an adaptor seated on an implant in apatient's jaw and having a differentiating adaptor reference indiciumand a prosthetic component having a differentiating prosthetic referenceindicium that is co-operable with the differentiating adaptor referenceindicium relative to each other to position the prosthetic componentinto a vertical and horizontal predetermined position in relation to theimplant; manufacturing a second prosthetic component based on thevertical and horizontal predetermined position; and inserting the secondprosthetic component on the implant such that the second prostheticcomponent is in a preferred position.